Slide 1

Closure of ventricular septal defect,continous versus conventional closure, comparative study Slide 2 Moustafa Abdelkhalek Moustafa Professor of cardiothoracic surgery Mansourah University Egypt Chest Hospital, Kuwait Slide 3 Aim of the work The purpose of this study is to investigate the effect of continuous suture technique Vs interrupted suture technique for ventricular septal defect closure, in pediatric patients Slide 4 METHODS: Eighty patients, divided into two groups, forty patients each, with mean age,(32.85 months in group one to 26.42 months in group two, were operated for VSD closure Slide 5 METHODS *Between January 2006 till January 2010, 40 patient operated upon with continuous suture technique group 2 and 40 with interrupted traditional technique group 1, *Inotropic support, complete heart block, complications, ventilation hours, ICU stay, hospital stay, and hospital cost were analyzed. Slide 6 METHODS Inclusion criteria : All cases with isolated VSDs Exclusion criteria: All cases of VSDs associated with other complex anomalies Slide 7 Table 1 showing demographic data in studied group group2group1 P valueSDM M 0.599 NS48.6426.4247.2932.85Age O.O25 S female 26 male 14 female 26 male 24Sex 1.966 NS7.617.0710.8811.2BW Slide 8 Table (2) showing diagnostic distribution in studied groups group1group2 No% %totalp value VSD3280%2562.50%570.18 NS VSD+PDA410%4 8 VSD+COA12.50%25%3 VSD+AR25%2 4 VSD+ASD12.50%717.50%8 Total40100%40100%80 Slide 9 Table (3) showing clinical presentation in studied groups group 1group 2 No% %TotalP value Asymptomatic1742.50%1537.50%320.19 NS CHF1025%1742.50%27 Failure to thrieve1025%410%14 Recurrent infection37.50%410%7 40100%40100%80 Slide 10 Table (4) showing echo and Cath. data in studied groups group 1group 2 No% %TotalP value RA+RV3791.50%2562.50%520.001 HS LA+LV37.50%1537.50%18 40100%40100%80 Cardiac cath done1640%3390%230.026 S 2460%717.50%57 40100%40100%80 Slide 11 Table (5) showing types of VSDs in studied groups group 1group 2 No% %TotalP value Perimembranous2562.50%3075%55 0.001 HS Muscular12.50%615%7 Subaortic1435%25%16 Subpulmonary00%25%2 Total40100%40100%80 Slide 12 Table (6) showing previous surgical procedures in studied groups group1group 2 No%N0%TotalP value Non3791.50%3587.50% 0.777 COA12.50%1 COA+PAB12.50%37.50% PAB12.50%1 Total4O4O100%40100% Slide 13 Table(7) showing operative data in studied groups. group 1group 2 No% %TotalP value ApproachRA1435%3997.50%530.0001 HS PA2163%17.50%22 RA+PA512.50%00%5 PatchGortex40100%1332.50%530.0001 HS Bovine615%1127.50%17 Equine00%1537.50%15 direct suture00%12.50%1 Slide 14 Table(8) operative data in studied groups Group 2Group 1 %No% Clamp timem 58.75sd 5.28m 73.47sd 23.080.001s Pump Tm 86.60sd 6.22m 73.47sd 32.540.016 s CBCM 365.0SD 198.5M 320.3SD 243.020.371 NS CHBsinus3587.50%3700.00%91.50%0.243 NS CHB37.50%3 2:1B25%00% Supportnon3382.50%00%0.000 HS adrenaline00%820% dopamine615%12.50% dobutrix00%12.50% milrinone12.50%375% Slide 15 Table (9) showing operative data in studied groups group1group 2 NO% %totalP value TEEnon3895%2460%620.000 HS done12.50%1640%17 Residual VSDnon40100%2562.50%550.000 HS there is00%1537.50%15 Tricuspid septal detachmentnon3690%3588%711.000 NS done4 10.00 %513%9 tricuspid valve repairnon3390%3390%660.4 NS commissural7 17.50 %615%13 annuloplasty00%12.50%1 Slide 16 Subaortic VSD Slide 17 Equine pericardial patch with continuous suture technique Equine pericardial patch with continuous suture technique Slide 18 Continuous suture technique for pm VSD closure Slide 19 Tricuspid septal detachment for good VSD exposure Slide 20 Subpulmonary VSD showing pulmonary valve Slide 21 Perimembranous VSD closed Slide 22 Commissural stitch repair of TV after VSD closure Slide 23 Perimembranous VSD with aortic valve showing through Slide 24 Conclusions: Continuous suture technique for closure of ventricular septal defect is safe and easy, with short ischemic time, pump time, short hospital stay, ICU stay, and total hospital cost. Slide 25 THANK YOU