Closure of muscular ventricular septal defects through a left ventriculotomy

Objective. To evaluate the results of closure of muscular ventricular septal defects through a left thoracotomy. Methods. Records of 23 children ope rated consecutively between 1972 and 1990 were studied. Age of patients was 2.8+/-3 years (2 months-10 years), weight 8.9+/-5.7 kg (2.6-22 kg). Ten patients (43%) had undergone one and 4 patients (17%) two previous cardiac operations. Late follow-up was obtained from direct examination of patients or from reports of their referring physicians. Bypass time was 89+/-28 min (66-167 min). The aorta was cross-clamped for 44+/-15 min (21-66 min). Until 1977 operations were performed with moderate hypothermia and intermittent aortic crossclamping. After 1978 deep hypothermia (20-25 degrees C) and cold crystalloid cardioplegia was used, Ventricular septal defects not accessible from other approaches were closed through a small fish-mouth incision in the apex of the left ventricle. Patients' data were sampled and stored in a computerised database, Risk factors were evaluated by stepwise logistic regression. Results. Four patients died in the hospital (17%); two died later. Two required reoperation for residual/recurrent defects. All patients, except two from abroad, were available for follow-up, which ranged from 36 months to 18 years (mean 11.3 years). All were in NYHA class 1. Only two risk factors were identified: the number of ventricular septal defects (P<0.05) and associated atrial septal defect (P<0.02). Early echocardiographic evaluation showed good LV size and function in all except one patient, who had a perioperative septal infarction. Late echocardiography pel formed in six patients demonstrated normal LV shortening without evidence of regional wall abnormality. Conclusions. Left ventriculotomy is a useful approach for closure of low muscular ventricular septal defects in selected patients.