Ventricular Septal Dysfunction After Surgical Closure of Multiple Ventricular Septal Defects Hironori Matsuhisa, MD, Naoki Yoshimura, MD, PhD, Tomonori.

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Ventricular Septal Dysfunction After Surgical Closure of Multiple Ventricular Septal Defects Hironori Matsuhisa, MD, Naoki Yoshimura, MD, PhD, Tomonori Higuma, MD, Takuro Misaki, MD, PhD, Yoshiko Onuma, MS, Fukiko Ichida, MD, PhD, Yoshihiro Oshima, MD, PhD, Yutaka Okita, MD, PhD The Annals of Thoracic Surgery Volume 96, Issue 3, Pages 891-897 (September 2013) DOI: 10.1016/j.athoracsur.2013.05.013 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Locations of the ventricular septal defects and closure techniques. The Annals of Thoracic Surgery 2013 96, 891-897DOI: (10.1016/j.athoracsur.2013.05.013) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 An example of a patient with multiple ventricular septal defects whose two midtrabecular ventricular septal defects (in the anteroseptum and septum) were individually closed using the sandwich technique. The left ventricular septal wall at the papillary muscle level was automatically subdivided into six segments. The radial displacement curves (left) show impaired systolic myocardial movement toward the contractile center of the anteroseptum (yellow) and septum (red). The radial strain curves (right) show impaired systolic wall thickening of the anteroseptum and septum. (Ant = anterior; AntSept = anteroseptum; AVC = aortic valve closure; Inf = inferior; Lat = lateral; Post = posterior; SAX PM = short axis papillary muscle; Sept = septum.) The Annals of Thoracic Surgery 2013 96, 891-897DOI: (10.1016/j.athoracsur.2013.05.013) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Correlation between the affected total patch area and the postoperative global ventricular function. (A) Ejection fraction; (B) Tei index. (BSA = body surface area.) The Annals of Thoracic Surgery 2013 96, 891-897DOI: (10.1016/j.athoracsur.2013.05.013) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Effects of the surgical techniques on (A) the regional peak systolic radial strain and (B) the peak systolic radial displacement. The Annals of Thoracic Surgery 2013 96, 891-897DOI: (10.1016/j.athoracsur.2013.05.013) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions