Continuous suture technique of ventricular septal defects on normothermic cardiopulmonary bypass in pediatric patients

Abstract

Results: 2 (3%) patients died in the early post operative period (within 30 days of surgery). Low cardiac output was the leading cause of death. 60 of the 63 survivors were followed up & the mean follow time was 5.2 years (SD±1.95). 85% patients were in functional class I while rest were in class II symptoms.Conclusions: Lutembachers complex presents a difficult & rare entity, although early recognition allows timely intervention with good results. Valve procedure depends mainly on the severity of the mitral valve disease which may be underestimated in presence of the shunt at the atrial level. Introduction:The concept of sub coronary implantation of the homograft in the aortic position was originally described by Ross. A clear understanding of the anatomy and spatial relation of the aortic root is essential for this technique.Methods: Between September 2003 and June 2005, we operated 12 cases, where in aortic homograft or pulmonary autograft was implanted in the aortic position by sub coronary implantation technique. The mean age of the patients was 32.5 (range 24 to 52 years).The lesions were stenotic in five and regurgitant in seven. The immediate post operative gradients were assessed by Trans esophageal Echocardiography and subsequently on the seventh day and third month by Trans thoracic Echo.Results: The average immediate postoperative gradients were marginally high, maximum of 42 mm Hg and mean of 24 mm Hg. The gradients subsequently decreased to a maximum of 32 mm Hg and mean of 18 mm Hg by the seventh day and a maximum of 14 mm Hg and mean of 8 mm Hg by the third month. Intraoperatively one patient developed dissection between the native aortic wall and the autograft at the level of the noncoronary cusp, which was corrected on table. On follow-up, one patient had developed significant homograft regurgitation and two patients had mild to moderate regurgitation.Conclusions: The immediate post operative gradients after subcoronary implantation technique is marginally high and eventually come down due to tissue shrinkage over several weeks. This technique needs a clear understanding of anatomy and spatial relation of aortic root.