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Corrective treatment of isolated ventricular septal defect in infancy
Insights
Intracardiac repair of ventricular septal defects (VSD) in infants is recommended when its risks are lower than staged procedures. This study presents successful VSD closure in infants, highlighting improved outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Intensive Care
Background:
- Ventricular septal defects (VSD) are common congenital heart anomalies.
- Surgical management of VSD in infants traditionally involved pulmonary artery banding followed by later repair.
- This approach carries significant cumulative mortality and morbidity.
Purpose of the Study:
- To evaluate the feasibility and outcomes of primary intracardiac correction of VSD in infants.
- To establish criteria for surgical intervention in this high-risk population.
- To compare the risks of primary repair versus staged procedures.
Main Methods:
- Intracardiac repair of VSD in 23 infants under one year of age.
- Utilized deep hypothermia and circulatory arrest to facilitate complex intracardiac repairs.
- Reviewed indications including intractable heart failure, pulmonary hypertension, and failed banding procedures.
Main Results:
- Achieved a 4% mortality rate and low morbidity in the studied infant cohort.
- Demonstrated the safety and efficacy of intracardiac VSD repair in infants.
- Highlighted risks associated with pulmonary artery banding procedures.
Conclusions:
- Intracardiac VSD correction in infants is indicated when operative risks are lower than staged approaches.
- Pulmonary artery banding should be reserved for specific complex cases, such as those with coarctation of the aorta or multiple muscular VSDs.
- Primary intracardiac repair offers a viable alternative with improved outcomes for many infants with VSD.
Abstract:
Intracardiac correction of VSD in infants should be indicated if the mortality and morbidity of the operation at this age group is lower than cumulative mortality of pulmonary artery banding plus second-staged procedure mortality. Experience with closure of VSD in 23 patients under 1 yr of age with 4% mortality and low morbidity is presented. Indications for operation are: (1) intractable heart failure; (2) persistence or progression of pulmonary hypertension; and (3) failure of banding procedure. Deep hypothermia and circulatory arrest facilitated the intracardiac repair in all patients. Mortality and morbidity related to the banding procedure are emphasized, and it is suggested that banding be restricted only to patients with associated coarctation of the aorta or to patients with multiple muscular ventricular septal defects in whom left ventriculotomy can be safely performed at an older age.