Abstract
Background and Aim : We showed in our anatomical review,
ventricular septal defects existing as multiple entities can be
considered in terms of three major subsets. We address here the
diagnostic challenges, associated anomalies, the role and techniques of
surgical instead of interventional closure, and the outcomes. including
reinterventions, for each subset.
Methods: We reviewed 80 published investigations, noting
radiographic findings, and the results of clinical imaging elucidating
the location, number, size of septal defects, and associated anomalies,
and the effect of severe pulmonary hypertension.
Results: Overall, perioperative mortality for treatment of
residual multiple defects has been cited to be between zero and 14.2%,
with morbidity estimated between 6% to 13%. Perioperative mortality is
twice as high for perimembranous compared to muscular defects, with need
for reoperation is over four times higher. Perventricular hybrid
approaches are useful for closure of high anterior or apical defects.
Overall, results have been unsatisfactory. Pooled data reveals
incidences between 2.8% and 45% for device-related adverse events.
Currently, however, outcomes cannot be assessed on the basis of the
different anatomical sub-sets.
Conclusions : We have addressed the approaches, and the results,
of therapeutic treatment in terms of co-existing discrete defects, the
Swiss-cheese septum, and the arrangement in which a solitary apical
muscular defect gives the impression of multiple defects when viewed
from the right ventricular aspect. Treatment should vary according to
the specific combination of defects.
Keywords: Congenital heart disease, Muscular ventricular septal
defects, Percutaneous device closure, Perventricular hybrid device
closure, Pulmonary artery banding, Swiss-cheese ventricular septal
defects