Aspects of surgery for congenital ventricular septal defect

In chapter 1, an outline of the thesis is given. This thesis focuses on aspects of surgical closure of a congenital ventricular septal defect. In Chapter 2, the accuracy and the potential of 3-D echocardiography in the preoperative assessment of a congenital VSD were evaluated. 3-D echocardiography can be considered a valuable diagnostic tool, which may accurately identify the location, size, and spatial relations of a VSD. Chapter 3 presents a surgical alternative by temporary tricuspid valve detachment, in the approach for the repair of a congenital VSD in patients in whom transatrial exposure of the VSD is inadequate. The procedure was significantly associated with patients that were younger, lighter in weight, shorter and more often on diuretic therapy. Regardless of the age, size and preoperative clinical condition of the patients, and regardless of the right ventricular load, temporary detachment of the tricuspid valve in closure of a congenital VSD can be performed safely, without any negative effect on growth or function of the valve at medium-term follow-up. Chapter 4 comments on temporary chordal detachment as an alternative to temporary detachment of the anterior or septal tricuspid leaï¬,et from the tricuspid annulus in repairing a congenital VSD in patients in whom transatrial exposure of the VSD is incomplete. This technique may be useful in selected cases; however, arguments in favour should preferably come from obvious advantages or from careful follow-up. Chapter 5 focuses on the differences between mild (32°C) and moderate (28°C) systemic hypothermia during the reconstruction of a congenital ventricular septal defect in paediatric patients. No differences were found regarding organ preservation and adequacy of cardio pulmonary bypass, nor in surgical exposure and clinical outcome. Chapter 6 demonstrates the clinical application of real time 3-D echocardiography in patients with a surgically corrected congenital ventricular septal defect. With I-Space technology, the complex postoperative cardiac anatomy of the closed congenital VSD can be appropriately visualised in virtual reality and provides a unique resource for postoperative quality control as well as for education with regard to the intracardiac repair of a congenital VSD. Chapter 7 provides a long-term follow-up study after surgical closure of a congenital ventricular septal defect. To enhance surgical exposure of the congenital ventricular septal defect in selected patients, the tricuspid valve was temporary detached from the tricuspid annulus and proved to be a safe method. Closure of a congenital ventricular septal defect can be performed with a low complication rate. Tricuspid valve detachment (TVD) results in less early postoperative tricuspid valve regurgitation and does not result in tricuspid valve dysfunction during follow-up. TVD results in comparable residual shunting as non-TVD. The incidence of trivial residual shunting is higher in small children irrespective of tricuspid valve detachment. Trivial residual shunting is expected to disappear spontaneously Chapter 8 provides a long-term follow-up study after surgical closure of a congenital ventricular septal defect at adult age with special emphasis to quality of life. The need for surgical closure of a congenital ventricular septal defect in adulthood is rare, but on the right indication, surgery is an adequate and safe procedure, with good results on long-term follow up. Quality of life of this adult VSD group is comparable with general population. In 10 out of twelve domains of the TAAQOL-questionnaire they had an equal score. Merely in 2 domains, cognitive functioning and sleep, our population differed from the general population with regard to the quality of life. Chapter 9 contains a general discussion regarding aspects of surgery of a congenital ventricular septal defect at paediatric and adult age.

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