Roy Varghese1, Sanni Saheed1, Amrutha K Ravi1, Ejaz Ahmed Sherrif1, Ravi Agarwal1, Sivakumar Kothandam2
1 Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India
2 Department of Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
Background: Conventional methods of closure of ventricular septal defects involve placement of sutures 4-5 mm from the posterior inferior margin. This study compares the conventional method with an alternative technique wherein sutures are placed along the edge of the defect thereby “excluding” the conduction system and the tensor apparatus of the tricuspid valve from the suture line.
Materials and Methods: Between January 2013 and January 2016, 409 consecutive patients were retrospectively reviewed and divided into two matched groups. Group A (n = 174) underwent closure using the alternative technique and Group B (n = 235) with the conventional technique. Patients with isolated ventricular septal defects (VSDs) (n = 136) were separately analyzed as were infants within this subset.
Results: Immediate postoperative results were similar with no statistically significant differences in either group in terms of incidence of residual defects or postoperative tricuspid regurgitation. There was however a significantly increased incidence of post operative complete heart block (CHB) among patients in the conventional group (P = 0.02). Incidence of temporary heart block that reverted to sinus rhythm was also more in the conventional method group (Group B) (P = 0.03) as was right bundle branch block (P ≤ 0.05) in all the subsets of patients analyzed.
Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed.
Institute of Cardiovascular Diseases, The Madras Medical Mission, 4-A, Dr. J.J. Nagar, Mogappair, Chennai - 600 037, Tamil Nadu
Source of Support: None, Conflict of Interest: None
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