Intraoperative Left Atrial Saline Flooding for Detection of Residual and Additional Ventricular Septal Defects: A Multicenter Retrospective Study of 2739 Pediatric Patients
Journal of Cardiac Surgery, cilt.2026, sa.1, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 2026 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1155/jocs/8951430
- Dergi Adı: Journal of Cardiac Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: intraoperative detection, pediatric cardiac surgery, residual VSD, saline flooding, ventricular septal defect
- Çukurova Üniversitesi Adresli: Evet
Özet
Background: Residual and additional (previously unrecognized) ventricular septal defects (VSDs) can complicate pediatric congenital heart surgery and may necessitate early reintervention. We evaluated the intraoperative detection yield and safety of left atrial saline flooding as a practical adjunct to intraoperative transesophageal echocardiography (TEE) in a large multicenter cohort. Methods: We retrospectively analyzed 2739 pediatric patients (mean age 2.6 years; 51% male) undergoing repair of isolated VSD (n = 1252), atrioventricular septal defect (AVSD; n = 644), or tetralogy of Fallot (TOF; n = 843) at four tertiary centers in Türkiye (2000–2023). Left atrial saline flooding was performed via a patent foramen ovale when present or a limited atrial septotomy when required, before separation from cardiopulmonary bypass (CPB), and used alongside intraoperative TEE. Mean additional CPB time attributable to the maneuver was 5 ± 1 min. Results: Saline flooding identified residual VSDs in 163 patients (5.9%) and additional VSDs in 218 patients (8.0%), with rates differing significantly by diagnosis (highest in AVSD: 12.6% residual and 16.0% additional; p < 0.001 across groups). All detected defects were revised immediately during the index operation. Discharge echocardiography showed 10 trivial residual shunts (0.36%), none requiring intervention. No complications were attributed to the saline flooding maneuver. Postoperative adverse events included prolonged mechanical ventilation (1.7%), arrhythmias (2.4%), and superficial surgical site infection (0.9%). Operative mortality, defined according to Society of Thoracic Surgeons (STS) criteria as death occurring during the index hospitalization or within 30 days postoperatively, was 0.29% (n = 8; AVSD: 5, TOF: 3). No surgical reoperation or transcatheter procedure was performed for residual/additional VSD closure during follow-up. Conclusions: Left atrial saline flooding is a safe, low-cost, and reproducible adjunct that can facilitate intraoperative identification and immediate correction of residual and additional VSDs prior to separation from CPB. Routine use may strengthen intraoperative quality control and reduce clinically significant residual shunting after pediatric congenital heart repairs.