Conclusions
Based on the published literature, we conclude that color-Doppler flow
mapping should allow precise delineation of the number, size, and
location of multiple defects in infants and children, and facilitate
planning of optimal strategy for intervention. The closure of
Swiss-cheese defects still presents a technical challenge, and carries
increased mortality. Use of an adjustable pulmonary arterial band is a
desirable option in premature infants with low body weight, and body
surface area less than 0.4m2, as it allows possible
spontaneous closure of some smaller defects. Following its use, other
defects can safely be closed on a bigger heart. Although oversized and
Sandwich patch techniques are recommended for reconstituting the
Swiss-cheese septum, biologic glue appears useful. Its downside is the
need for
extensive division or transection of right ventricular trabeculations
for optimal visualization, with the potential long-term risk of
myocardial and septal dysfunction.
Apical left or right ventriculotomies reliably provide access to apical
defects, simplifying placement of patches, preserving ventricular volume
compliance, and avoiding complications related to transection of
trabeculations. With the current development of device closure, left
ventriculotomy may be replaced in highly specialized centers by
transcatheter or hybrid procedures. Perventricular device closure is
here to stay. This means that surgeons should firmly embrace and study
this new technology. For most teams, nonetheless, interventional or
hybrid procedures are not recommended in premature infants, nor for
those with low body weight or with the true Swiss-cheese septum.