Surgical management of multiple ventricular septal defects.

Between Jan. 1, 1973, and June 1, 1979, 29 patients underwent surgical closure of multiple ventricular septal defects (VSDs). Included are 19 patients with VSDs only (one death), five with tetralogy of Fallot (TF) (0 deaths), two with transposition of the great arteries and VSD (TGA/VSD) (one death), two with complete atrioventicular (AV) canal (one death), and one with common atrium (one death). The overall hospital mortality rate was 14% (4/29) and was significantly related to the complexity of the underlying malformation (p = 0.01) and the presence of major associated cardiac lesions (p = 0.005). The incidence of reoperation for overlooked VSDs was 28% (8/29) and was significantly related to the presence of muscular VSDs (all overlooked defects were muscular) and the failure preoperatively to diagnose multiple VSDs (p = 0.05). Of patients with shunt data available after the final operation, 85% (17/20) had a Qp/Qs less than or equal to 1.5, and no patient had a final Qp/Qs > 2.0. This experience indicates that satisfactory results usually can be achieved after operation for multiple VSDs and emphasizes the value of early assessment for residual shunting and reoperation when indicated.