Reply to Liu and Bu

We would like to thank Drs. Liu and Bu for their interest in our report where we evaluated differences in postoperative conduction disorders between shallow-bite continuous and interrupted suturing for tetralogy of Fallot and isolated perimembranous outlet-type ventricular septal defects (VSD) [1]. We found in favour of shallow-bite continuous suturing for reducing postoperative right bundle branch block incidence, shortening the PQ interval, and lowering heart rates for perimembranous outlet-type VSD closures in tetralogy of Fallot repairs. Liu and Bu [2] introduced a combined suturing technique featuring shallow-bite and interrupted suturing on the postero-inferior rim while continuous suturing is routine elsewhere. This avoids the occurrence of the residual shunt at the postero-inferior rim and reduces the risk of conduction disorders. Their technique is justifiable, especially in complex areas involving chordae and papillary muscles, and gives flexibility to conventional continuous suturing applications. On the other hand, our shallow-bite continuous suturing keeps the suturing line exactly parallel and adjacent to the VSD margin, reducing conduction system injury risk. The VSD margin, in our experience, should be free from any other cardiac structures unless straddling or overriding atrioventricular valves. The stitches on the postero-inferior rim of the VSD are placed within a depth of 1.0 mm and within a horizontal distance of 2.0 mm from the rim, well away from the conduction system, and, furthermore, patch dependability is guaranteed with resilient endocardium. Special attention to stitch direction, tissue depth and assistant following helps to avoid tissue avulsion and residual shunting. In our study, we observed no significant residual shunting in addition to favourable outcomes.