“Swiss cheese” septal defects: surgical closure using a single patch with intermediate fixings

Background. Residual ventricular septal defects and ventricular and septal dysfunctions are surgical drawbacks of “Swiss cheese” defects. We developed a technique that uses a single patch with intermediate fixings to cover the right side of the septum without producing a septal bulging, through a right atriotomy. Methods. Since April 1993, 5 children with “Swiss cheese” defects have been operated on using this procedure (mean age, 17 ± 12 months). Three patients had associated lesions including tetralogy of Fallot, Taussig Bing heart, and mitral stenosis. Results. There have been no early or late deaths. The mean follow-up time is 29 ± 18 months. All patients are asymptomatic. Echocardiography revealed either an intact septum (n = 4) or insignificant color jets at the apical portion of the septum (n = 1). The septal wall motion was preserved in 4 children and was hypokinetic in the fifth child. Conclusions. This technique can be an additional tool to provide a secure closure of “Swiss cheese” defects even in the presence of associated cardiac lesions. Long-term consequences of this procedure on septal wall motion remain to be determined.