Left Ventricular Performance Following Apical Left Ventriculotomy

Replogle, Robert L.

doi:10.1001/archsurg.1967.01330180040007

Cited by 10 publications

(34 citation statements)

References 9 publications

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“…The morbidity and mortality rates among patients with apical mVSDs, however, has remained high, primarily resulting from difficulties associated with inadequate exposure and incomplete closure because of the presence of numerous muscular trabeculations and moderator bands overlying the defects. Several approaches have been developed for closure of these difficult defects . Apical left ventriculotomy was introduced and rapidly adopted as the most effective approach for surgical closure of apical mVSDs.…”

Section: Discussionmentioning

confidence: 99%

“…Apical left ventriculotomy was introduced and rapidly adopted as the most effective approach for surgical closure of apical mVSDs. Left ventriculotomy may provide excellent visualization and complete closure of muscular defects in the lower part of the trabecular septum from the smooth LV side of the septum . However, observations of late myocardial dysfunction, formation of apical aneurysms, and arrhythmogenesis have been reported.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of Apical Muscular Ventricular Septal Defects Using the Sandwich Technique

Zhou

et al. 2013

J Card Surg

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Management of Apical Muscular Ventricular Septal Defects Using the Sandwich Technique

Zhou

et al. 2013

J Card Surg

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“…[19][20][21][22][23][24][25][26][27][28][51][52][53][54][55] Orthotopic cardiac transplantation Cardiac transplantation has been recommended for extremely large apical septal defects with severe biventricular dysplasia, and persistent ventricular dysfunction following closure of Swiss-cheese septal defects through apical left ventriculotomy. 6,8,[29][30][31][32]41,42,47,[56][57][58][59][60]…”

Section: Hybrid Closure Of Multiple Apical Muscular Septal Defectsmentioning

confidence: 99%

A Review of the Therapeutic Management of Multiple Ventricular Septal Defects

Chowdhury

Anderson

Spicer

et al. 2021

Preprint

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Background and Aim: We showed in our anatomical review, ventricular septal defects existing as multiple entities can be considered in terms of three major subsets. We address here the diagnostic challenges, associated anomalies, the role and techniques of surgical instead of interventional closure, and the outcomes. including reinterventions, for each subset. Methods: We reviewed 80 published investigations, noting radiographic findings, and the results of clinical imaging elucidating the location, number, size of septal defects, and associated anomalies, and the effect of severe pulmonary hypertension. Results: Overall, perioperative mortality for treatment of residual multiple defects has been cited to be between zero and 14.2%, with morbidity estimated between 6% to 13%. Perioperative mortality is twice as high for perimembranous compared to muscular defects, with need for reoperation is over four times higher. Perventricular hybrid approaches are useful for closure of high anterior or apical defects. Overall, results have been unsatisfactory. Pooled data reveals incidences between 2.8% and 45% for device-related adverse events. Currently, however, outcomes cannot be assessed on the basis of the different anatomical sub-sets. Conclusions: We have addressed the approaches, and the results, of therapeutic treatment in terms of co-existing discrete defects, the Swiss-cheese septum, and the arrangement in which a solitary apical muscular defect gives the impression of multiple defects when viewed from the right ventricular aspect. Treatment should vary according to the specific combination of defects.

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“…Left ventriculotomy may provide excellent visualization and complete closure of muscular defects in the lower part of the trabecular septum from the smooth left ventricular (LV) side of the septum. [27][28][29][30][31][32][33] A small "fi sh-mouthed" incision in the LV apex was made, 20,27,28 starting in the relatively avascular LV apical area with limited extension superiorly and away from and parallel to the anterior and posterior descending coronary arteries. Care to not disturb the coronary artery distribution is essential for minimizing coronary artery injury.…”

Section: Apical Left Ventricular Approachmentioning

confidence: 99%

Surgical management of muscular trabecular ventricular septal defects

Asou

2011

Gen Thorac Cardiovasc Surg

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Despite recent advances in diagnosis, surgical techniques, and postoperative care of children with congenital cardiac defects, muscular trabecular ventricular septal defects (VSDs) are still a therapeutic challenge. Among these defects, it is more difficult to achieve secure and complete closure of low trabecular or apical VSDs because of the presence of numerous muscular trabeculations overlying the defect. When they are associated with "Swiss cheese"-type of VSDs, it is almost impossible to visualize the true edges of the defect through the transatrial approach. Consequently, there remains an unacceptable incidence of mortality and morbidity when compared to those that occur with closure of the usual perimembranous VSD. Although various techniques for closure of these difficult trabecular VSDs have been attempted, there is still a significant incidence of complications in the surgical management of trabecular VSDs, mostly significant residual shunts, a need for multiple reoperations, and severe left ventricular dysfunction. This article describes the anatomical details and classification of muscular trabecular VSDs. It also reviews several techniques currently utilized and their outcomes.

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Left Ventricular Performance Following Apical Left Ventriculotomy

Cited by 10 publications

References 9 publications

Surgical Management of Apical Muscular Ventricular Septal Defects Using the Sandwich Technique

Surgical Management of Apical Muscular Ventricular Septal Defects Using the Sandwich Technique

A Review of the Therapeutic Management of Multiple Ventricular Septal Defects

Surgical management of muscular trabecular ventricular septal defects

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