Closure of Isolated Doubly Committed Sub arterial Ventricular Septal Defect through Pulmonary Artery versus Trans ventricular Closure

Background: Doubly committed sub-arterial ventricular septal defects is a type of ventricular septal defects located beneath the aortic and pulmonary valve and represent approximately 5 % of all ventricular septal defects. This type of ventricular septal defect has a low tendency for spontaneous closure and associated with aortic valve leaflets prolapse as well as insufficiency. Trans pulmonary arterial approach is standard approach for repair this type of ventricular septal defects. Objective: To review the results of transpulmonary arterial approach in repair isolated doubly committed subarterial ventricular septal defects and compare it with that of transventricular approach. Methods: this is a retrospective comparative study applied for 23 patients underwent open heart surgery for repair their isolated doubly committed subarterial ventricular septal defects at Ibn -Alnafees teaching cardiothoracic hospital in Baghdad, Iraq from 1st of January 2012 to 1st of January 2022.Those patient divided to two groups ,group 1 (9 patients) trans pulmonary arterial approach applied ,group 2 (14 patients) trans ventricular approach used .Their collected data studied and compared between group1and group 2 according to aortic cross clamp time , cardiopulmonary bypass time , intensive care unit stay , prolong mechanical ventilation ,need of inotropic support ,residual shunt , postoperative tachyarrhythmia , postoperative right ventricular systolic function and mortality. Results: age group of (6 to10years) was the common age group in this study ,12 patients of 23 patients belong to this age group (53.83%) , female (14 patients) was common gender (61.54%) ,female :male ratio was 1.5:1. The mean aortic cross clamp was 45 minutes in group 1 and 54.71 minutes in group 2, mean cardiopulmonary bypass time was 63 minutes in group1 and 73.61 minutes in group 2.The mean intensive care unit stay was 2 days in group 1 , while was 3.11 days in group 2. Prolong mechanical ventilation (more than 10 hours) seen in 6 patients belong to group 2 (44.45%) and 2 patients belong to group 2 need reintubation (11.11%) . All patients in group 2 needed inotropic support (100%) and 5 patients of them need full support (33.34%). postoperative tachyarrhythmia noted in 10 patients of 14 patients belong to group 2 (77.78%) ,residual shunt also seen in 3 patients belong to group 2 (22.22%).Postoperative depress right ventricular systolic function founded in all patients of group 2 (100%) and classified as mild abnormal (3 patients) , moderate abnormal(8 patients )and sever abnormal (3 patients).Mortality was (11.11%)in group 2 , while in group 1 Reintubation and mechanical ventilation were not found beside no need for inotropic support , there were 0% for tachyarrythmia, serious complications and mortality. Conclusion: transpulmonary arterial approach safe and feasible to repair isolated doubly committed sub arterial ventricular septal defects and its, results were superior to that of transventricular approach.