Surgery of isolated multiple ventricular septal defects: A series of 175 consecutive cases.

Between January 1980 and September 1995, 175 children were operated for closure of isolated multiple ventricular septal defects (VSD) (mean age 20 +/- 8 months, mean weight 8.1 +/- 4.4 kg). Eighty-nine patients had pulmonary protection : pulmonary artery banding (n = 76) and pulmonary valvular stenosis (n = 13). The remainder had severe pulmonary hypertension (mean pulmonary systolic pressures : 75.7 +/- 20.5 mmHg). The surgical strategy was based on the site of the VSD and the ventricular dominance determined preoperatively or at surgery. The VSD were perimembranous in 141 cases, muscular in 175 cases, of the inlet septum in 19 cases and infundibular in 13 cases. A surgical approach throught a right atriotomy was adequate for complete repair in 122 patients; a second approach was necessary by right (n = 35) or left ventriculotomy (n = 4) or both (n = 2) or via the pulmonary artery in 2 cases. The operative mortality was 7.4% (13 patients). The causes of death were : residual (VSD (n = 6), pulmonary hypertension (n = 2), ventricular hypoplasia (n = 2), myocardial infarction (n = 3). Of the 162 survivors, 33 had residual VSDs, 12 were reoperated once (n = 11) or twice (n = 1). The mortality was 54.5%. The patients were classified in two groups : Group I (n = 130), those operated before 1990, and Group II (n = 45), the ones operated afterwards. The low muscular VSDs and left ventriculotomy were risk factors for mortality in univariate analaysis for Group I and the a Swiss Cheese type for Group II.