Transesophageal Echocardiography Detection of Undiagnosed Multiple Muscular Ventricular Septal Defects with Alteration of Shunt Flow by Right Ventricular Pacing After an Arterial Switch Operation in a Neonate

The management of patients with multiple muscular trabecular ventricular septal defects (VSDs) remains controversial. In the past two decades, innovative techniques including a right ventricular apical infundibulotomy and transcatheter, intraoperative and perventricular device closure have been exploited, and essential right atrial approach and limited apical left ventriculotomy have also been refined. However, specific management guidelines for this difficult disease have not been established. In this article, the benefits and drawbacks of each technique are reviewed and discussed. Primary repair for infants with multiple muscular trabecular VSDs was associated with good late outcomes. The right atrial approach was satisfactory for all muscular VSDs, excluding apical defects that were well seen through a limited apical ventriculotomy. Surgical closure of apical defects could be achieved safely and completely in early infancy through a limited apical left ventriculotomy or a right ventricular apical infundibulotomy. Further follow-up and prudent evaluations of ventriculotomy-associated morbidities are needed. Pulmonary artery banding should be limited to a small infant with complex associated defects. Percutaneous device closure, the most desirable option, is impractical due to limitations between the delivery system and access route. Intraoperative device closure appears less successful than device closure in the catheterization laboratory. Perventricular device closure has a significant advantage of being a non-bypass procedure approach. A less invasive strategy for "true" Swiss cheese septum is needed. All may have an important role, and results obtained by using these techniques are encouraging. These hybrid approaches will promise future success on management guidelines of multiple muscular trabecular VSDs.

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Techniques and results in the management of multiple muscular trabecular ventricular septal defects

Kitagawa

Kitaichi

Sugano

et al. 2013

Gen Thorac Cardiovasc Surg

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Coronary Artery to Left Ventricle Fistulas After Septal Myectomy

Haddy

2015

Anesthesia &Amp; Analgesia

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Iatrogenic Mitral Regurgitation After Muscular Ventricular Septal Defect Repair Detected by Transesophageal Echocardiography in a Pediatric Patient

et al. 2019

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Transesophageal Echocardiography Detection of Undiagnosed Multiple Muscular Ventricular Septal Defects with Alteration of Shunt Flow by Right Ventricular Pacing After an Arterial Switch Operation in a Neonate

Cited by 4 publications

References 7 publications

Techniques and results in the management of multiple muscular trabecular ventricular septal defects

Techniques and results in the management of multiple muscular trabecular ventricular septal defects

Coronary Artery to Left Ventricle Fistulas After Septal Myectomy

Iatrogenic Mitral Regurgitation After Muscular Ventricular Septal Defect Repair Detected by Transesophageal Echocardiography in a Pediatric Patient

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