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Author Sharma, Vikas ♦ Greason, Kevin L. ♦ Nkomo, Vuyisile T. ♦ Schaff, Hartzell V. ♦ Burkhart, Harold M. ♦ Park, Soon J. ♦ Suri, Rakesh M. ♦ Dearani, Joseph A.
Source World Health Organization (WHO)-Global Index Medicus
Content type Text
Publisher Wiley
File Format HTM / HTML
Language English
Difficulty Level Medium
Subject Domain (in DDC) Social sciences ♦ Sociology & anthropology ♦ Natural sciences & mathematics ♦ Life sciences; biology ♦ Physiology & related subjects ♦ Natural history of organisms ♦ Technology ♦ Medicine & health ♦ Human anatomy, cytology, histology ♦ Human physiology ♦ Diseases ♦ Surgery & related medical specialties ♦ Manufacture for specific uses ♦ Precision instruments & other devices
Subject Domain (in MeSH) Cardiovascular System ♦ Anatomy ♦ Eukaryota ♦ Organisms ♦ Cardiovascular Diseases ♦ Pathological Conditions, Signs and Symptoms ♦ Diseases ♦ Surgical Procedures, Operative ♦ Investigative Techniques ♦ Analytical, Diagnostic and Therapeutic Techniques and Equipment ♦ Circulatory and Respiratory Physiological Phenomena ♦ Biological Sciences ♦ Social Sciences ♦ Anthropology, Education, Sociology and Social Phenomena ♦ Persons ♦ Persons
Subject Keyword Discipline Cardiology ♦ Discipline Surgery ♦ Cardiac Surgical Procedures ♦ Mortality ♦ Methods ♦ Heart Septal Defects, Ventricular ♦ Etiology ♦ Surgery ♦ Myocardial Infarction ♦ Complications ♦ Adult ♦ Aged ♦ Aged, 80 And Over ♦ Atrial Pressure ♦ Physiology ♦ Blood Loss, Surgical ♦ Female ♦ Follow-up Studies ♦ Forecasting ♦ Heart Atria ♦ Heart Valve Prosthesis Implantation ♦ Statistics & Numerical Data ♦ Heart Ventricles ♦ Hospital Mortality ♦ Humans ♦ Male ♦ Middle Aged ♦ Preoperative Period ♦ Retrospective Studies ♦ Tricuspid Valve ♦ Ventricular Dysfunction, Right ♦ Physiopathology ♦ Journal Article
Abstract BACKGROUND: We describe our contemporary experience for the management of patients with an acute postinfarction basal ventricle septal defect (VSD) using the transatrial (TA) and transventricular (TV) approaches. METHODS: Retrospective review of all patients diagnosed with an ischemic basal VSD since January 2000. There were 20 patients with a median age of 68 years (39 to 85); 13 (65%) were males. Median time from diagnosis of the ischemic basal VSD to operation was 22 hours (6 to 144). RESULTS: All patients received standard patch closure of the septal defect with exposure of the VSD through the TA approach in eight patients (40%) and the TV approach in 12 (60%). All TA group patients received tricuspid valve replacement, while in the TV group, two had tricuspid valve replacement and two repair. Five patients (25%) had clinically insignificant (<0.5 mm) residual septal defects; three additional patients (15%) experienced patch dehiscence and two (10%) underwent re-exploration. There were five mortalities (25%): one in the TA group (right ventricular heart failure) and four in the TV group (one right ventricular heart failure, three ventriculotomy site hemorrhage or patch dehiscence). Preoperative right atrial pressure (p=0.0003) and right ventricular dysfunction (p=0.04) were predictors of hospital mortality. Follow-up of the hospital survivors was 4.3 years (40 days to 11.5 years) with one death at seven years. CONCLUSION: Operative mortality associated with repair of postinfarction basal ventricular septal defect is high and is related to right ventricular failure and bleeding from the ventriculotomy. The TA approach avoids ventriculotomy-associated bleeding and provides excellent exposure but is associated with an increased incidence of tricuspid valve replacement.
Description Author Affiliation: Sharma V ( Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.)
ISSN 08860440
Educational Role Student ♦ Teacher
Age Range above 22 year
Educational Use Reading ♦ Research ♦ Self Learning
Interactivity Type Expositive
Education Level UG and PG
Learning Resource Type Article
Publisher Date 2013-09-01
Publisher Place United States
e-ISSN 15408191
Journal Journal of Cardiac Surgery
Volume Number 28
Issue Number 5


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Source: WHO-Global Index Medicus