About 60% of small ventricular septal defects
close spontaneously. The remaining 40% require open heart
surgery. In most infants, the defect can be permanently corrected
surgically during the first year of life.
The repair takes place under direct
visualization of the defect, and the septum is closed with either
a simple suture technique or, in most instances, the insertion of
a synthetic prosthetic or pericardial patch.
The procedure begins with the patient positioned supine (on his/her back).
- The sternum is exosed and divided in the middle
- The heart must be
quieted and blood flow stopped to visualize the defect. Extracorporeal circulation using cardiopulmonary bypass is often required to support the body during surgery. Other techniques such as total circulatory arrest and profound hypothermia are sometimes used.
- Surgical access to the VSD depends upon it's location and the presence of other cardiac defects.
- The right ventricle is often opened to gain access to perimembranous
or inlet defects.
- The right atrium may be used to close trabecular and infundibular defects
- The pulmonary artery may be used to close outlet septum VSDs
- Smaller defects are often sutured closed.
- Large defects may be repaired using a dacron, teflon
felt, Gortex, or xenograft pericardium patch sutured into place to occlude the space. In
time, septal tissue will grow across the gap and
completely knit the patch in place.
- Regardless of the VSD location, care will be taken to protect cardiac structures, especially branches of the conduction system.
- Preoperative and postoperative
prophylactic antibiotics are often required to prevent
- The child should be assessed
postoperatively for dysrhythmia, since edema in the
septum may interfere with conduction.
The sutures are
placed around the defect and passed through the patch (white
circular object with cross on picture above). The patch is moved
into place and the sutures are tied. This picture shows the
repair of an atrial septal defect. Suture placement through the patch is
similar in VSD repair. The tubes shown in the picture are part of
the extracorporeal perfusion equipment ("heart-lung"
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