Ventricular Septal Defect

Abstract

Closure of a ventricular septal defect (VSD) is one of the most important procedures in all of congenital heart surgery because these defects occur as a part of so many cardiac anomalies. The types of surgical exposures have varied over time. Initially, to effect accurate closure, extended ventriculotomies were performed to visualize the entire VSD, but over time, this approach induced right ventricular arrhythmias and various degrees of right ventricular dysfunction. Surgeons then developed a right atrial approach, which is used almost exclusively today. The surgical VSD repairs shown in this text are performed by interrupted, pledgeted suture technique using a Dacron or Gore-Tex patch. Other surgeons may use running suture technique and, in certain circumstances, open device closure, especially with muscular VSD. We selectively employ running suture technique in small babies when the VSD closure is associated with arterial switch, interrupted aortic arch, and other very complex procedures where conserving cross-clamp time is a consideration. Our bias to use interrupted, pledgeted suture technique stems from our published series showing a very low incidence of residual defects. We feel that the slightly longer cross-clamp time associated with this technique is time well spent to ensure accurate suture placement and optimal patch position. Caution and judgment concerning extended ischemic arrest times will dictate the type of closure technique that is best suited to the patient and the surgeon.