This was an evaluation of a new approach to the management of multiple muscula r ventricular septal defects. The defects were located with epicardial echocardi ography, then transfixed with a guide wire inserted directly through the right v entricular free wall. They were closed with a custom-made multilayered double- patch device under cardioplegic arrest through a standard right atriotomy. This was a retrospective study of 14 consecutive patients. The median age and body we ight at repair were 40 days(range 1 week8 years, 3 months) and 4.1 kg (2.8-24 k g), respectively. Five patients(36%) had undergone at least one previous sterno tomy; 11 patients(78%) had associated cardiac lesions. Closure of the multiple septal defects was successful in 12 patients(85%). Failure to localize all defe cts led to pulmonary artery banding in 2 patients. One patient had the residual septal defect closed with a percutaneous device 6 months later, and in the secon d patient the residual defect was closed with a conventional approach 11 months afterward. Two patients had permanent pacemaker insertion. In 279 patient-month s of follow-up, there was 1 cardiac arrest on day 1 and no early or late deaths ; all children but one are free of cardiac medications, and no sig nificant residual left-to-right shunts were demonstrated in any patient. The reported management of multiple ventricular septal defects has been successful in this series, even in neonates and infants with complex associated cardiac les ions. It appears safe, simple, and effective.
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