Explain Ventricular septal defects VSD Chsude Technique ?
Ventricular septal defects are closed on cardiopulmonary bypass. Approach is through median stemotomy. Ascending aortic and bicaval cannulations are done and tapes passed around SVC *mad IVC. After aortic is clamped and aortic mot cadioplegia is give11 right atrium is opened. Left atrium is vented either through patent foramen ovale or through incised septum. Most of perimembranous, inflow and muscular VSDs can be closed bug$ right atrium. Tricuspid valve is retracted and VSD margins m visualised. Closure is done using properly sized Dacron or Goretex patch using 5 '0" continuous prolene sutures. Some surgeons prefer to use intercepted pledgetted sutures b close VSD. Care is taken to avoid injury to bundle of HIS that runs on the postern-inferior margin of VSD on the left ventricular aspects of muscular septurm. A sub pulmonic (infundibular septal) VSD can be closed through an incision on the pulmonary artery and retraction of pulmonary valve (trans pulmonary). VSD can also be closed through a ventricular This is less ideal compared to transatrial and transpulmonary approach as ventriculotomy can cause some reduction in ejection of right ventricle.
Multiple muscular defects (Swiss cheese defects) were once approached through left ventriculotomy. This approach is not done now for fear of compromising LV function.