Muthuvijayan, T (2013) Comparative study between interrupted and continuous suture techniques in ventricular septal defect patch closure: A Retrospective analysis. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: In this study we propose to follow up patients undergoing repair for ventricular septal defect over a two year period and look at the variables in relation to the different techniques of operation, materials used for closure, and eventual morbidity and mortality related to the operation. Ventricular septal defect is the most common congenital cardiac anomaly that may occur as an isolated anomaly or as a part of complex of anomaly such as tetralogy of fallot. Smal defects may close spontaneously, and others may cause no significant disability in an entire lifetime. Patients with cardiomegaly and large left to right shunts are unquestionable candidates for the operation. By operating electively, the tendency to develop valvulitis and Bacterial Endocarditis is virtually eliminated. AIM OF THE STUDY: A comparison of Interrupted and Continuous Suture technique for closure of Ventricular septal defects. OBJECTIVES: To study our experience regarding the effectiveness, postoperative complication rates and the total outcome comparing Interrupted and continuous suturing for closure of Ventricular septal defects done in Department of Cardiothoracic surgery, Government Rajaji Hospital from October 2010 to December 2012. MATERIAL AND METHODOLOGY All Patients for ventricular septal defect closure was done by professor. All patients undergoing repair for ventricular septal defect in Department of Cardiothoracic surgery, Government Rajaji Hospital during October 2010 to December 2012 were included in the study. Patients with VSD associated with complex anomalies and muscular type VSDs were excluded from this study. One group used continuous suture for VSD closure and the other group used Interrupted techniques for VSD closure. After median sternotomy, the thymus was dissected from the pericardium. Pericardium harvested as a free graft taking care to avoid injury to the phrenic nerves. It was treated with 0.6% glutaraldehyde solution for 20 minutes and rinsed 3 times in 0.9% saline solution for 5 minutes. Cardiopulmonary bypass was started after AORTA, SVC, IVC cannulation. Under moderate hypothermia, cross clamp applied, antegrade cold blood cardioplegia given. Heart arrested in diastole Right atrium was opened and the VSD was inspected. The pericardial/Gore-Tex patch was trimmed to match the size of the VSD. The defect was closed with the pericardial patch using 4/0 or 5/0 polypropylene continuous suture; starting from the inferior margin and proceeding towards the antero superior margin and superiorly towards the aortic valve, avoiding injury to the aortic cusps. With the second arm of the suture, the postero-inferior margin was closed up to the septal leaflet of the tricuspid valve. The tricuspid margin of the defect was closed with a reinforcing strip of pericardium. When using interrupted sutures pledget supported interrupted mattress sutures are first placed around all margins of the defect and then passed through an appropriately tailored patch, which is lowered down and tied in. LIMITATIONS: This study is limited by its non-randomized nature and the inherent limitations of non-randomized studies. Only those patients who were referred for surgery and underwent surgical repair were reviewed. Indications for surgery are based on the retrospective review of the referring cardiologist’s clinical notes and the surgical preoperative note. Although this study did not address long term follow up for these patients, long-term survival and clinical outcomes for patients after surgical closure of isolated VSD are consistently excellent, and we would anticipate the same for this study population. In addition, we intentionally excluded patients with multiple VSDs. We recognize that patients with multiple VSDs can be a challenging group for surgical repair. However, the focus of this study was patients with isolated, single VSD. CONCLUSION: Continuous and interrupted suture techniques are equally effective in closure of ventricular septal defect. Eventhough residual shunt is common with continuous suture techniques in VSD closure, 7 percentage cases of residual shunt occurred in interrupted suture techniques in our institutions which is statistically insignificant. Incidence of infective endocarditis is slightly higher in interrupted when compared to continuous suture techniques in our institutions, could be explained by more number of pledgets used in interrupted technique which is also statistically insignificant. Because of the small number of groups included in our study, we are unable to come to conclusion and suggesting large randomized control study to ascertain this.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | interrupted and continuous suture techniques, ventricular septal defect patch closure, Retrospective analysis, Comparative study. |
| Subjects: | MEDICAL > Cardio Vascular and Thoracic Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Jan 2020 04:01 |
| Last Modified: | 10 Jan 2020 04:01 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11763 |
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