1. Closure of ventricular septal defect,continous versus conventional closure, comparative study

2. Moustafa Abdelkhalek Moustafa Professor of cardiothoracic surgery Mansourah University Egypt Chest Hospital, Kuwait

3. Aim of the work The purpose of this study is to investigate the effect of continuous suture technique Vs interrupted suture technique for ventricular septal defect closure, in pediatric patients

4. METHODS: Eighty patients, divided into two groups, forty patients each, with mean age,(32.85 months in group one to 26.42 months in group two, were operated for VSD closure

5. METHODS *Between January 2006 till January 2010, 40 patient operated upon with continuous suture technique group 2 and 40 with interrupted traditional technique group 1, *Inotropic support, complete heart block, complications, ventilation hours, ICU stay, hospital stay, and hospital cost were analyzed.

6. METHODS Inclusion criteria : All cases with isolated VSDs Exclusion criteria: All cases of VSDs associated with other complex anomalies

7. Table 1 showing demographic data in studied group group2group1 P valueSDM M 0.599 NS48.6426.4247.2932.85Age O.O25 S female 26 male 14 female 26 male 24Sex 1.966 NS7.617.0710.8811.2BW

8. Table (2) showing diagnostic distribution in studied groups group1group2 No% %totalp value VSD3280%2562.50%570.18 NS VSD+PDA410%4 8 VSD+COA12.50%25%3 VSD+AR25%2 4 VSD+ASD12.50%717.50%8 Total40100%40100%80

9. Table (3) showing clinical presentation in studied groups group 1group 2 No% %TotalP value Asymptomatic1742.50%1537.50%320.19 NS CHF1025%1742.50%27 Failure to thrieve1025%410%14 Recurrent infection37.50%410%7 40100%40100%80

10. Table (4) showing echo and Cath. data in studied groups group 1group 2 No% %TotalP value RA+RV3791.50%2562.50%520.001 HS LA+LV37.50%1537.50%18 40100%40100%80 Cardiac cath done1640%3390%230.026 S 2460%717.50%57 40100%40100%80

11. Table (5) showing types of VSDs in studied groups group 1group 2 No% %TotalP value Perimembranous2562.50%3075%55 0.001 HS Muscular12.50%615%7 Subaortic1435%25%16 Subpulmonary00%25%2 Total40100%40100%80

12. Table (6) showing previous surgical procedures in studied groups group1group 2 No%N0%TotalP value Non3791.50%3587.50% 0.777 COA12.50%1 COA+PAB12.50%37.50% PAB12.50%1 Total4O4O100%40100%

13. Table(7) showing operative data in studied groups. group 1group 2 No% %TotalP value ApproachRA1435%3997.50%530.0001 HS PA2163%17.50%22 RA+PA512.50%00%5 PatchGortex40100%1332.50%530.0001 HS Bovine615%1127.50%17 Equine00%1537.50%15 direct suture00%12.50%1

14. Table(8) operative data in studied groups Group 2Group 1 %No% Clamp timem 58.75sd 5.28m 73.47sd 23.080.001s Pump Tm 86.60sd 6.22m 73.47sd 32.540.016 s CBCM 365.0SD 198.5M 320.3SD 243.020.371 NS CHBsinus3587.50%3700.00%91.50%0.243 NS CHB37.50%3 2:1B25%00% Supportnon3382.50%00%0.000 HS adrenaline00%820% dopamine615%12.50% dobutrix00%12.50% milrinone12.50%375%

15. Table (9) showing operative data in studied groups group1group 2 NO% %totalP value TEEnon3895%2460%620.000 HS done12.50%1640%17 Residual VSDnon40100%2562.50%550.000 HS there is00%1537.50%15 Tricuspid septal detachmentnon3690%3588%711.000 NS done4 10.00 %513%9 tricuspid valve repairnon3390%3390%660.4 NS commissural7 17.50 %615%13 annuloplasty00%12.50%1

16. Subaortic VSD

17. Equine pericardial patch with continuous suture technique Equine pericardial patch with continuous suture technique

18. Continuous suture technique for pm VSD closure

19. Tricuspid septal detachment for good VSD exposure

20. Subpulmonary VSD showing pulmonary valve

21. Perimembranous VSD closed

22. Commissural stitch repair of TV after VSD closure

23. Perimembranous VSD with aortic valve showing through

24. Conclusions: Continuous suture technique for closure of ventricular septal defect is safe and easy, with short ischemic time, pump time, short hospital stay, ICU stay, and total hospital cost.

25. THANK YOU