A unidirectional-valve patch for repair of intraventricular septal defects compicated by high pulmonary hypertension and bidirectional (alternating) shunt

This paper deals with the efficiency of applying a unidirectional valve patch to surgically repair intraventricular septal defects (IVSD) combined with high pulmonary hypertension (HPHT) and bidirectional (alternating) shunt. This technique was used for 28 patients with IVSD and HPHT with bidirectional shunt at Loyan Central Hospital in Khanan province, Republic of China. Results: Left-right shunt at a ventricular level was observed in 20 patients after 20 hours and in 8 patients in 14 days after the operation. 1 patient died on the twelfth day after surgery, he had prolonged apparent hemolysis of indeterminate genesis that contributed to the development of acute renal insufficiency (lethality 3.6 %). There was no lethality resulting from low cardiac output. Long-term results were obtained over a period from 3 to 24 months. According to subjective criteria 25 patients out of 27 discharged ones apparently improved their quality of life. When applying the valve patch, saturation was equal to 90-96 % (93±2 %). Two patients showed right-left shunt during three months. The pulmonary-systemic pressure ratio exceeded 70 % in 11 patients and was below 70 % in 16 patients. To surgically repair IVSD combined with HPHT and bidirectional (alternating) shunt, it is necessary to use a unidirectional-valve patch, which allows for the right-left shunt on a ventricular level, thus decreasing the load on the right heart. The method described is useful for lowering the risk of development of complications and postoperative mortality associated with HPHT.