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A Review of the Therapeutic Management of Multiple Ventricular Septal Defects
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  • Ujjwal Chowdhury,
  • Robert Anderson,
  • Diane E. Spicer,
  • Lakshmi Sankhyan,
  • Niwin George,
  • Niraj Pandey,
  • Balaji Arvind,
  • Shikha Goja,
  • Vishwas Malik
Ujjwal Chowdhury
All India Institute of Medical Sciences
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Robert Anderson
1Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom Birmingham Children’s Hospital, Birmingham, United Kingdom
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Diane E. Spicer
Johns Hopkins All Children's Hospital
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Lakshmi Sankhyan
All India Institute of Medical Sciences
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Niwin George
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Niraj Pandey
All India Institute of Medical Sciences
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Balaji Arvind
All India Institute of Medical Sciences
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Shikha Goja
All India Institute of Medical Sciences
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Vishwas Malik
All India Institute of Medical Sciences
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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.
20 Sep 2021Submitted to Journal of Cardiac Surgery
21 Sep 2021Assigned to Editor
21 Sep 2021Submission Checks Completed
23 Oct 2021Review(s) Completed, Editorial Evaluation Pending
24 Oct 2021Editorial Decision: Accept
May 2022Published in Journal of Cardiac Surgery volume 37 issue 5 on pages 1361-1376. 10.1111/jocs.16289