Congenital - VSD
- The anatomy of the atrioventricular conduction system in relation to ventricular septal defects (VSDs) has been demonstrated histologically since the early 1960s.1,2 Subsequently, surgeons adopted strategies to close VSDs while avoiding atrioventricular conduction and that has resulted in a remarkable decrease in the incidence of complete heart block following surgical repair of VSDs.3,4 In the account following up the early pioneering work of Lillehei repairing congenital heart defects, 4 of 27 patients in whom defect closure was attempted developed complete heart block.
- Iatrogenic heart block remains a risk factor for surgical closure of ventricular septal defects (VSDs), with a reported incidence between 2% and 8%. In a single-center, retrospective study with more than 800 patients (mean age, 14 months) undergoing operation between 2001 and 2009, a total of 64 patients (7.7%) developed iatrogenic atrioventricular block. Forty-eight of them (75%) had transient atrioventricular block, whereas 16 (1.9%) required pacemaker implantation.1 Patients weighing <4 kg and those with inlet VSD were more likely to develop atrioventricular block following surgical VSD repair.
- The ability to visualize the structure of the conduction tissue of the heart has substantial implications for the electrophysiologist and surgeon. In the article by Yoshitake and associates1 in the current issue of the Journal, application of phase-contrast computed tomography to cadaver hearts with ventricular septal defects provided a more comprehensive understanding of the structure of the conduction tissue and its relationship to the ventricular septal defect. The importance of understanding the precise location of conduction tissue to avoid injury during surgery and the implications for surgical planning in congenital heart disease are self-evident.
- To visualize and quantify the atrioventricular conduction axis in the setting of ventricular septal defect using phase contrast computed tomography.
- Interventricular septal hematoma (IVSH) is rarely reported in association with congenital cardiac surgical repair and is more commonly related to cardiac trauma or myocardial infarction in the adult cardiac patient. When linked to congenital cardiac surgery, the few cases reported are usually in conjunction with a perimembranous ventricular septal defect (VSD) repair. Although the mechanism for IVSH is not clear, the leading theory involves injury to the septal perforating artery during suture placement in the VSD repair.
- Interventricular septal hematoma (IVSH) is a rare complication, which may result from ventricular septal defect (VSD) repair. IVSH can result in conduction and/or hemodynamic abnormalities related to impaired ventricular filling or outflow tract obstruction. We report the novel use of extracorporeal membrane oxygenation (ECMO) for management.
- The architecture of the interventricular septum is still disputed. Whether it is a bilayer structure with overlapping helical bands of muscle1,2 or a trilayer structure with alternating fiber orientations,3 however, its distinct layers may represent fault lines, separable into fracture planes by a dissecting hematoma.
- Midline unifocalization has been developed for the surgical treatment of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. All patients will eventually require reoperation due to the presence of a conduit, and some may also require revision of the distal unifocalized bed. The purpose of this study was to evaluate the surgical results of unifocalization revision.
- Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries represents a real challenge to the congenital cardiac surgical community. Unifocalization is the process of changing this abnormal multicompartmental pulmonary vascular bed into a normal single compartment through surgical reconstruction. The aim is to unite all these multiple different sources of pulmonary blood flow into a uniform compartment, with the goal of having the lowest possible pulmonary arterial (PA) to right ventricular (RV) pressure ratio to ensure satisfactory long-term outcomes.