HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul R. Vogt Marko I. Turina Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by von Segesser, L. K. Articles by Turina, M. I. Search for Related Content PubMed PubMed Citation Articles by von Segesser, L. K. Articles by Turina, M. I. Related Collections Related Article

Ann Thorac Surg 1995;60:511-515
© 1995 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Prevention of Residual Ventricular Septal Defects With Fibrin Sealant

Clinics for Cardiovascular Surgery and Pediatric Cardiology, University Hospital, Zürich, Switzerland

Background. Modern echocardiography now allows for the detection of a substantial number of residual ventricular septal defects (VSDs) after surgical patch repair that remained hidden in the past. Mostly without hemodynamic significance, residual VSDs may have clinical consequences (progressive dehiscence, hemolysis, prophylactic antibiotic treatment, endocarditis). To reduce the number and size of residual VSDs we performed an experimental and a clinical study.

Methods. (1) In an experimental setup, burst pressure of 60 fibrin glue-sealed defects (calibrated between 1.0 and 5.0 mm in diameter) was determined using a computerized recording system and pressure loads up to 500 mm Hg. (2) In a prospective clinical trial with blinded postoperative echocardiographic controls VSD closure was performed in 36 consecutive patients (age, 37 ± 40 months; range, 4 to 134 months) using a polytetrafluoroethylene patch and running sutures reinforced with pledgets (22 of 36 patients) or sealed with fibrin glue (14 of 36 patients) in accordance to the surgeon's preference.

Results. (1) Experimentally, mean pressure load achieved was more than 500 ± 0 mm Hg for 1.0-mm defects, 413 ± 52 mm Hg for 2.5-mm defects, 363 ± 58 mm Hg for 4.0-mm defects, and 313 ± 48 mm Hg for 5.0-mm defects (r 0.873, p < 0.001). (2) Clinically, all patients survived. Residual VSDs at echocardiography were observed in 16 of 22 patients (72%) for reinforced versus 5 of 14 patients (36%) for sealed with fibrin glue (p < 0.05). Diameter of residual VSDs accounted for 1.3 ± 1.2 mm for reinforced versus 0.3 ± 0.4 mm for sealed with fibrin glue (p < 0.01). Hemodynamically significant residual VSDs were found in 2 of 22 patients (9%) for reinforced versus 0 of 14 patients (0%) for sealed with fibrin glue (p = not significant).

Conclusions. Small defects sealed with fibrin glue resist physiologic pressure load. Fibrin glue sealing of prosthetic patches during intracardiac VSD repair allows for significant reduction of number and size of residual VSDs. Improved long-term outcome can be expected.

Related Article

Discussion
Ann. Thorac. Surg. 1995 60: 515-516. [Extract] [Full Text]

This article has been cited by other articles:

				A. Haussler and R. Pretre Surgical closure of a perimembranous ventricular septum defect with a running suture MMCTS, May 23, 2008; 2008(0523): 2410. [Abstract] [Full Text] [PDF]

				S. A. LeMaire, S. A. Carter, T. Won, X. Wang, L. D. Conklin, and J. S. Coselli The Threat of Adhesive Embolization: BioGlue Leaks Through Needle Holes in Aortic Tissue and Prosthetic Grafts Ann. Thorac. Surg., July 1, 2005; 80(1): 106 - 111. [Abstract] [Full Text] [PDF]

				A. F. Merrick, M. Lal, R. H. Anderson, and D. F. Shore Management of ventricular septal defect: a survey of practice in the United Kingdom Ann. Thorac. Surg., September 1, 1999; 68(3): 983 - 988. [Abstract] [Full Text] [PDF]