The role of intraoperative device closure in the management of muscular ventricular septal defects

Abstract

The contemporary surgical management of multiple ventricular septal defects (VSDs) carries a relatively high mortality rate in comparison to that of other biventricular repairs. Several innovative approaches have been recommended for repair of multiple VSDs, but none are uniformly successful in achieving complete elimination of ventricular shunting without causing ventricular dysfunction. This is especially true in cases with highly deficient ventricular septa, the so-called "Swiss cheese" anomaly. The recent introduction of the CardioSEAL (NMT Medical Inc, Boston, MA) double-clamshell device led to an evaluation of intraoperative device-mediated closure of muscular VSDs. Taken in context with our overall experience in the surgical management of multiple VSDs, we suggest that device-mediated closure of muscular VSDs is a useful and potentially ventricular function-sparing option for this challenging problem.