Frequency and Surgical Management of Residual Ventricular Septal Defects

¹ Department of Surgery, University of Minnesota Medical Center

Residual and recurrent ventricular septal defects have occurred in 42 (18 per cent) of 231 patients who have been recatheterized after repair of ventricular septal defects. This includes both isolated ventricular septal defects and those associated with tetralogy of Fallot. A majority of these residual defects had been previously closed by the suture technique, confirming the fact previously ascertained from recatheterization studies that larger defects are best closed by the patch technique. In one patient with a small residual shunt, "spontaneous" closure due to healing has been observed.

Fifteen of the 42 patients have been operated upon for their residual shunts. These residual defects were located, for the most part, in the posterior and superior aspect of the original defect (membranous). In four patients, the residual shunt was from left ventricle to right atrium, although originally all were isolated ventricular defects. These residual shunts were clearly due to the pulling out of the original stitches placed into tricuspid valve leaflet tissue rather than into the fibrinous tricuspid annulus.

Complete heart block and re-entry through the former ventriculotomy site were responsible for most of the postoperative complications and mortality.

An approach through a right posterolateral thoracotomy and atriotomy with detachment of the tricuspid septal leaflet when necessary and use of a patch repair if the residual defect was large have obviated many of the problems previously encountered in reoperations.

Nine patients have been recatheterized after their reoperation, and eight are completely cured. The only exception was an unusual patient in whom the original defect was due to trauma with multiple leaks through the muscular septum and trabeculæ carnæ.