TY - JOUR
T1 - Current topics in surgery for multiple ventricular septal defects
AU - Yoshimura, Naoki
AU - Fukahara, Kazuaki
AU - Yamashita, Akio
AU - Doki, Yoshinori
AU - Takeuchi, Katsunori
AU - Higuma, Tomonori
AU - Senda, Kazutaka
AU - Toge, Masayoshi
AU - Matsuo, Tatsuro
AU - Nagura, Saori
AU - Aoki, Masaya
AU - Sakata, Kimimasa
AU - Sakai, Mari
N1 - Publisher Copyright:
© 2015, Springer Japan.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - In this review article, we describe several topics, including the sandwich technique, the transatrial re-endocardialization technique, the limited apical left ventriculotomy approach and device closure. The sandwich technique was introduced for the closure of muscular ventricular septal defects (VSD) by sandwiching the septum between two felt patches placed in the left and right ventricle. This technique requires neither the transection of muscular trabeculae nor ventriculotomy. Although the sandwich technique has resulted in the improvement of surgical outcomes, cases of postoperative cardiac dysfunction have been reported. Multiple smaller VSDs have been closed with transatrial re-endocardialization. Septal dysfunction may be avoided through this technique, in which the septal trabeculae are approximated in two layers of superficial, endocardial running sutures. Recently, a number of reports have recommended a limited apical left ventriculotomy approach. With this technique, a much shorter incision of around 1 cm at the apex of the left ventricle may be sufficient for achieving the complete closure of apical muscular VSDs. The transcatheter or perventricular device closure of muscular VSDs has increasingly been performed with good results. Although favorable early and mid-term results of device closure have been reported, this method is not always safer or less invasive than surgical closure. Long-term evaluations should be performed to determine whether the right and left ventricular functions are affected by treatment with relatively large devices in the heart.
AB - In this review article, we describe several topics, including the sandwich technique, the transatrial re-endocardialization technique, the limited apical left ventriculotomy approach and device closure. The sandwich technique was introduced for the closure of muscular ventricular septal defects (VSD) by sandwiching the septum between two felt patches placed in the left and right ventricle. This technique requires neither the transection of muscular trabeculae nor ventriculotomy. Although the sandwich technique has resulted in the improvement of surgical outcomes, cases of postoperative cardiac dysfunction have been reported. Multiple smaller VSDs have been closed with transatrial re-endocardialization. Septal dysfunction may be avoided through this technique, in which the septal trabeculae are approximated in two layers of superficial, endocardial running sutures. Recently, a number of reports have recommended a limited apical left ventriculotomy approach. With this technique, a much shorter incision of around 1 cm at the apex of the left ventricle may be sufficient for achieving the complete closure of apical muscular VSDs. The transcatheter or perventricular device closure of muscular VSDs has increasingly been performed with good results. Although favorable early and mid-term results of device closure have been reported, this method is not always safer or less invasive than surgical closure. Long-term evaluations should be performed to determine whether the right and left ventricular functions are affected by treatment with relatively large devices in the heart.
KW - Device closure
KW - Limited apical left ventriculotomy
KW - Muscular VSD
KW - Sandwich technique
KW - Transatrial re-endocardialization
UR - http://www.scopus.com/inward/record.url?scp=84959075652&partnerID=8YFLogxK
U2 - 10.1007/s00595-015-1180-9
DO - 10.1007/s00595-015-1180-9
M3 - 総説
C2 - 25935205
AN - SCOPUS:84959075652
SN - 0941-1291
VL - 46
SP - 393
EP - 397
JO - Surgery Today
JF - Surgery Today
IS - 4
ER -