Closure of ventricular septal defect,continous versus conventional closure, comparative study

Moustafa Abdelkhalek Moustafa Professor of cardiothoracic surgery Mansourah University Egypt Chest Hospital, Kuwait

Aim of the work The purpose of this study is to investigate the effect of continuous suture technique Vs interrupted suture technique for ventricular septal defect closure, in pediatric patients

METHODS: Eighty patients, divided into two groups, forty patients each, with mean age,(32.85 months in group one to months in group two, were operated for VSD closure

METHODS *Between January 2006 till January 2010, 40 patient operated upon with continuous suture technique group 2 and 40 with interrupted traditional technique group 1, *Inotropic support, complete heart block, complications, ventilation hours, ICU stay, hospital stay, and hospital cost were analyzed.

METHODS Inclusion criteria : All cases with isolated VSDs Exclusion criteria: All cases of VSDs associated with other complex anomalies

Table 1 showing demographic data in studied group group2group1 P valueSDM M NS Age O.O25 S female 26 male 14 female 26 male 24Sex NS BW

Table (2) showing diagnostic distribution in studied groups group1group2 No% %totalp value VSD3280% % NS VSD+PDA410%4 8 VSD+COA12.50%25%3 VSD+AR25%2 4 VSD+ASD12.50%717.50%8 Total40100%40100%80

Table (3) showing clinical presentation in studied groups group 1group 2 No% %TotalP value Asymptomatic % % NS CHF1025% %27 Failure to thrieve1025%410%14 Recurrent infection37.50%410% %40100%80

Table (4) showing echo and Cath. data in studied groups group 1group 2 No% %TotalP value RA+RV % % HS LA+LV37.50% % %40100%80 Cardiac cath done1640%3390% S 2460%717.50% %40100%80

Table (5) showing types of VSDs in studied groups group 1group 2 No% %TotalP value Perimembranous %3075% HS Muscular12.50%615%7 Subaortic1435%25%16 Subpulmonary00%25%2 Total40100%40100%80

Table (6) showing previous surgical procedures in studied groups group1group 2 No%N0%TotalP value Non % % COA12.50%1 COA+PAB12.50%37.50% PAB12.50%1 Total4O4O100%40100%

Table(7) showing operative data in studied groups. group 1group 2 No% %TotalP value ApproachRA1435% % HS PA2163%17.50%22 RA+PA512.50%00%5 PatchGortex40100% % HS Bovine615% %17 Equine00% %15 direct suture00%12.50%1

Table(8) operative data in studied groups Group 2Group 1 %No% Clamp timem 58.75sd 5.28m 73.47sd s Pump Tm 86.60sd 6.22m 73.47sd s CBCM 365.0SD 198.5M 320.3SD NS CHBsinus % %91.50%0.243 NS CHB37.50%3 2:1B25%00% Supportnon %00%0.000 HS adrenaline00%820% dopamine615%12.50% dobutrix00%12.50% milrinone12.50%375%

Table (9) showing operative data in studied groups group1group 2 NO% %totalP value TEEnon3895%2460% HS done12.50%1640%17 Residual VSDnon40100% % HS there is00% %15 Tricuspid septal detachmentnon3690%3588% NS done %513%9 tricuspid valve repairnon3390%3390%660.4 NS commissural %615%13 annuloplasty00%12.50%1

Subaortic VSD

Equine pericardial patch with continuous suture technique Equine pericardial patch with continuous suture technique

Continuous suture technique for pm VSD closure

Tricuspid septal detachment for good VSD exposure

Subpulmonary VSD showing pulmonary valve

Perimembranous VSD closed

Commissural stitch repair of TV after VSD closure

Perimembranous VSD with aortic valve showing through

Conclusions: Continuous suture technique for closure of ventricular septal defect is safe and easy, with short ischemic time, pump time, short hospital stay, ICU stay, and total hospital cost.

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