Ventricular septal defect surgical repair

and Leida Perez, M.D.

Associate Editor-in-Chief: Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu]

Surgical technique for Repair of Perimembranous VSD
a) Perimembranous VSD is repaired on cardiopulmonary bypass with ischemic arrest. Device closure is rarely used in the United States because of the reported incidence of early and late onset complete heart block after device closure, presumably secondary to device trauma to the AV node.

b) Surgical exposure is achieved through the right atrium. The tricuspid valve septal leaflet is retracted or incised to expose the defect margins.

c) Several patch materials are available, including native pericardium, bovine pericardium, PTFE (Goretex(tm) or Impra(tm), or dacron.

d) Suture techniques include horizontal pledgeted mattress sutures, and running polypropylene suture.

e) Critical attention is necessary to avoid injury to the conduction system located on the left ventricular side of the interventricular     septum near the papillary muscle of the conus.

f) Care is taken to avoid injury to the aortic valve with sutures.

g) The heart is extensively deaired by venting blood through the aortic cardioplegia site, and by infusing Carbon Dioxide into the operative field to displace air.

h) Intraoperative transesophageal echocardiography is used to confirm secure closure of the VSD, function of the aortic valve, ventricular function, and the elimination of all air from the left side of the heart.

i) The sternum is closed, with potential placement of a local anesthetic infusion catheter under the fascia, to stabilize postoperative pain control.

j) A video of Perimembranous VSD repair, including the operative technique, and the daily postoperative recovery, can be seen here: VSD Repair, Perimembranous Ventricular Septal Defect Repair Video