Objetive: To describe our experience in surgical closure of ventricular septal defects (VSD) with double patch technique in paediatric patients with increased pulmonary vascular resistance (PVR).
Methods: We studied retrospectively 24 patients (63% female), with a mean age of 7 years (range, 1 to 18 years) and VSD associated with increased PVR (10.6 ± 5.6 U Wood) that were operated with double patch VSD closure at a 4 year period. We describe the early and mid term outcome with emphasis in morbidity and mortality.
Results: The defects were classified as simple (VSD as an isolated lesion) in 18 cases (75%), or complex (VSD associated with other mayor cardiac lesions) in 6 cases (25%). All VSD were closed with a bovine pericardial patch with a mean restrictive fenestration of 5.3mm (range, 4.5 to 8mm). Another small patch was placed at the left side of the first one in order to allow a unidirectional right to left shunt. Only one of these patients died in the early postoperative period because of pulmonary hypertension. Early morbidity causes were: pulmonary hypertension (8 cases: 36%), right ventricular failure (5 cases: 23%) and pneumonia (3 cases: 14%). There have been no deaths in the mid term follow-up and only one case (4.5%) developed severe mitral and aortic regurgitation.
Conclusions: Placement of a unidirectional flap valve VSD patch in children with pulmonary hypertension and increased PVR has reasonable morbidity and mortality, and reduces the need for ECMO or nitric oxide in these high risk group of patients.