Biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch and right ventricle apex excluding technique in 9 infants: surgical experiences and clinical results

Objective To reviewe our clinical experience on biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch and right ventricle apex excluding technique in 9 infants. Methods From March 2014 to March 2019, a series of 9 patients(M/F=2/7) with Swiss-cheese ventricular septal defects were admitted in our center to receive surgical treatment, with a median age of 4.8(2-12) months and a median body weight of 4.5(3.7-6.8) kg. All the 9 cases were symptomatic with shortness of breath and sweating. All the patients received echocardiography, ECG and chest X-ray. 3 patients with other intracardiac anomalies received CT angiography and 1 with severe pulmonary hypertension had transcatheter angiography. 4 cases of 9 had antenatal echocardiography but with no positive findings. The median cardiothoracic ratio was 0.63(0.58-0.72). 8 cases underwent one-stage surgical repair with the two-patch and right ventricle apex excluding technique and 1 case received a second-stage surgical repair with the same technique following a previous pulmonary artery banding procedure. The surgical repair was carried out with cardiopulmonary bypass under moderate hypothermia and using HTK cardioplagia to stop the heart in all the 9 cases. 2 fresh autologous pericardium patchs were used to closure defects of the outflow tract area and the apex trabecular defects respectively by excluding the apex of the right ventricle from the right ventricular inflow. Other intracardiac anomalies were corrected simultaneously. Patients were strictly followed up with a stanard protocol. Results All the operations were successful. Median cardiopulmonary bypass time and aortic clamping time were 96(68-167)min and 68(43-122)min respectively. Delayed chest closure were done in 2 cases within 48-72 hours postoperatively. The time of mechincal ventilation and ICU stay were 131.3(32-328)hours and 8.7(5-31)days respectively. All the patients were discarged in 11.5(9-42)days after operation. There was no mortality and major complication except for 1 case of low cardiac output syndrome, 2 cases of ventilator associated pnumonia and 2 cases of residual shunt(less than 2 mm). All the patients were followed up for 3.2 years(1 month-9 years). There was no death and major complication. The latest echocardiography results showed that the left and right heart function was normal in all the cases. Conclusion Biventricular surgical repair of Swiss-cheese ventricular septal defects with two-patch of fresh autologous pericardium and right ventricle apex excluding technique in infants can be relatively easy with favorable early and mid-term results. Long term results need to be evaluated with more cases. Key words: Ventricular septal defects; Surgical repair