Ventricular septal defects with pressure-overloaded right ventricle haemodynamic challenges

ABSTRACT

The right ventricular function is compromised in the presence of severe pulmonary hypertension and/or severe right ventricular outflow obstruction. Evolution in the medical and surgical management has improved the outcome in pressure overloaded right ventricle [RV]. This report describes two patients, aged 16 and 4 years. Echocardiogram and cardiac catheterisation revealed a large sub aortic ventricular septal defect [VSD] with elevated pulmonary artery pressures [PAP] in the first case, and pulmonary atresia, VSD, double outlet right ventricle, severely hypoplastic LPA, and a functioning Blalok Tausig shunt in the second case. The anaesthetic challenges of RV support are described, as well as the surgical technique in VSD repair, using valved patch closure to act as a pressure release valve to decompress the RV during hypertensive episodes. An innovative surgical technique for patients with over loaded RV, which were hitherto considered inoperable, is illustrated, emphasizing the role of anaesthetic management