Criteria for Reoperation and its Results in Recurrent Ventricular Septal Defects

From July 1985 through May 1995, 1167 patients underwent surgical closure of ventricular septal defect (VSD), including 682 patients having complex cardiac pathologies in the Institute of Cardiology, University of İstanbul and in Florence Nihgtingale Hospital. 21 of them required reoperation with the diagnosis of recurrent VSD (1.8 %). Indications for reoperation included significant left-to-right shunt (Qp/Qs>L5) and congestive heart failure in 20 patients and infective endocarditis with congestive heart failure in one. Reoperations were carried out 15 days to 84 months (mean 15.4 months) after the first operation. Patients' ages ranged from 20 months to 25 years (mean 10.2 years). All patients have been operared on with the technique of standard cardiopulmonary bypass, moderate hypothermia and cardioplegic arrest. Localization of the recurrent VSD's in relation to patch was posteroinferior in 16 and anterosuperior in 5 patients. In all cases except two, recurrent VSD was closed with double or triple primary suture technique, and in two exceptions having distortion in aortic valve and infective endocarditis, the patch was removed and a new one was replaced. One patient died with septicemia and multiorgan fa ilure in the postoperative 2nd month (mortality: 4.7%). Ventricular septal defects had been closed with continuous suture technique at the first operation in 20 patients who required reoperation. We have never seen any clinically important recurrent VSD after we began to use interrupted suture technique with pledgets. We conclude that closure of VSD's with a patch by using interrupted suture technique will decrease the ineidence of recurrence. The operation period is not lengthened by this method.