The Reopened Ventricular Septal Defect

Abstract

The persistence of a left-to-right shunt due to the unsuccessful repair of a ventricular septal defect associated with infundibular stenosis has been described. A characteristic clinical picture has been reported. The main features include congestive heart failure, tricuspid insufficiency, and increased pulmonary blood flow. The severity of the symptoms appears to be due to the persistence of a left-to-right shunt at a time when the myocardium has been affected adversely by such operative insults as potassium arrest and ventriculotomy. The particular difficulties attending the repair of a ventricular septal defect with infundibular stenosis include the proximity of the defect to the hypertrophied muscle mass, the soft muscular margin of such a defect, and the tension on the suture line. Ivalon and Teflon prostheses have been disappointing in their failure to maintain the integrity of the repair. All of the patients were reoperated upon. Five survived and their defects are now closed. The second repairs were abetted by the development of a fibrous scar around the margin of the defect. The five survivors are in good health and there is no evidence of a remaining shunt. As a consequence of these experiences, surgical technics were modified. The defects are now closed by direct suture with interrupted silk, followed by the application of a crimped Dacron patch over the repair. The results have been encouraging and since the new technic has been adopted, there have been virtually no recurrences.