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FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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The Journal of Cardiovascular Surgery 2003 Febbraio;44(1):51-4

CARDIAC SECTION 

 ORIGINAL ARTICLES

Does direct visualization of peripatch areas in beating heart eliminate the risk of residual ventricular septal defect in adult patients?

Yilmaz A. T.

Depart­ment of Car­di­o­vas­cular Sur­gery, Gul­hane Mil­i­tary Med­ical ­Academy, ­Ankara, ­Turkey

Aim. ­Although the inci­dence of ­residual ven­tric­ular ­septal ­defect (VSD) fol­lowing sur­gical ­therapy in the ­modern ­series is ­very low, espe­cially the ­risk of hemo­dy­nam­i­cally insig­nif­i­cant ­shunt ­still ­exists. Intra­op­er­a­tive assess­ment of ­residual ­shunt is ­useful in iden­ti­fying ­patients at ­risk of ­having sub­se­quently ­required reop­er­a­tion and reinter­ven­tion for ­residual VSD ­before ­chest clo­sure.
­Methods. In 87 ­patients who ­were oper­ated ­because of iso­lated VSD (­Group I), VSD was ­closed ­under car­di­o­plegic ­arrest and ­right atri­otomy or ­right ven­tric­u­lotomy ­were ­closed in the ­beating ­heart ­after ­aortic ­cross-­clamp ­removal. The VSD ­patch was ­watched out for ­residual ­shunt and addi­tional ­sutures ­were ­placed if it ­existed. ­Results of ­this tech­nique ­have ­been com­pared ­with the ­other 216 (­Group II) in ­which all pro­ce­dures of the VSD clo­sure ­were per­formed ­under car­di­o­plegic ­arrest. Trans­oseph­a­geal ech­o­car­di­og­raphy (TEE) was per­formed for evi­dence of ­residual ­shunting intra­op­er­a­tively and post­op­er­a­tively in all ­patients.
­Results. In ­group I, addi­tional ­sutures ­were ­placed for ­residual ­shunt in 14 ­patients (16.1%), and insig­nif­i­cant ­residual ­shunt was ­detected in ­only one (1.1%) ­patient at ­early post­op­er­a­tive ­period (p<0.05, ­according to ­group II). In ­group II, ­there was hemo­dy­nam­i­cally insig­nif­i­cant ­residual ­shunt in 31 ­patients (14.5%), and 9 ­patients (4.2%) ­were reop­er­ated for sig­nif­i­cant ­shunt (p<0.05).
Con­clu­sion. Trans­atrial or trans­ven­tric­ular inspec­tion to per­i­patch ­areas in the ­beating ­heart is a ­safe tech­nique to ­detect a ­residual ­shunt, an obser­va­tion ­that may elim­i­nate reop­er­a­tion.

lingua: Inglese


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