Abstract
Apical multiple muscular ventricular septal defects (VSDs) are difficult
to visualize, and closing these VSDs is technically troublesome. For
these reasons, the surgical outcome of the lesion is unsatisfactory.
Some surgical techniques have been reported to improve the outcome, but
they are not definite. We present a case with atrial septal defect,
multiple muscular and perimembranous VSDs, and pulmonary hypertension
due to high pulmonary blood flow. In the first operation during the
infantile period, the patient received closure of the perimembranous and
muscular VSD through the right atrium and atrial septal defect closure.
However, postoperative pulmonary blood flow was not decreased compared
with that of before the operation, and pulmonary hypertension was also
not improved. In addition to these lesions, tricuspid valve
insufficiency was also observed after the operation. Postoperative
computed tomography showed channels of apical muscular VSDs in the apex
of the right ventricle. In the second operation, exclusion of apex
muscular VSDs using the felt sandwich technique and tricuspid valve
repair were performed. After closing multiple muscular VSDs during the
operation, pulmonary blood flow was significantly decreased, and
pulmonary hypertension was improved as well. After the second operation,
postoperative echocardiography and catheter examination showed decreased
VSD shunt and pulmonary blood flow, resulting in improved pulmonary
hypertension.