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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2003 February;44(1):51-4

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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