Methods
We searched the extant literature for the described instances of the
management of multiple ventricular septal defects. We then collated the
demographics, the anatomical details encountered, the indications for
surgery or intervention, and outcomes of management, including
reinterventions. The search engines employed were PubMed, Google
Scholar, Cochrane Database for Systematic Reviews, Cochrane Central
Register of Controlled Trials, Ovid Medline, ACP Journal Club, Ovid
EMBASE, and Database of Abstracts of Review of Effectiveness in all
languages.
Analysis was based initially on the individualized review of the initial
77 investigations. These were then incorporated, as far as possible,
with the results and recommendations from the Congenital Heart Surgery
Database as provided by the Society of Thoracic Surgeons. The society
has collated the findings from 116 participating centers. We also took
note of the scientific statement of the American Heart Association,
endorsed by the American Academy of Pediatrics and the Society for
Cardiovascular Angiography and Intervention.29-32 So
as to unify the divergent approaches to the description and
categorization of ventricular septal defects, we assessed the reports,
as far as was possible, on the basis of the categorization proposed for
the Eleventh Iteration of the International Classification of Disease,
as produced by the International Society for Nomenclature of Pediatric
and Congenital Heart Diseases.33,34
Due to the limited sizes of the descriptive case series reported, and
the heterogeneity of clinical states at the time of surgical
intervention, along with the difficulties in selection of appropriate
cardiac quantifiable end points, we are unable to perform a
meta-analysis. Our analysis therefore, is based on review of case
reports, and small case series, along with incorporation of data from
the extensive series published by the Society of Thoracic Surgeons
Registry, the scientific statement of the American Heart Association,
and the report from the International Society for Nomenclature of
Pediatric and Congenital Heart Diseases.28-34