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Published on: November 29, 2018
Repair of ventricular septal defect after pulmonary artery banding
Insights
Two-stage surgical repair for infants with ventricular septal defect (VSD) and pulmonary artery banding (PAB) is safe. This approach effectively treats severe VSD in early infancy, with good long-term outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Surgery
Background:
- Ventricular septal defect (VSD) is a common congenital heart anomaly.
- Infants with severe VSD often require early intervention.
- Two-stage surgical repair, involving pulmonary artery banding (PAB) followed by total repair, is a strategy for managing these complex cases.
Purpose of the Study:
- To evaluate the safety and reliability of a two-stage surgical approach for ventricular septal defect (VSD) in infants.
- To assess long-term outcomes, including mortality and residual hemodynamic issues, following this surgical strategy.
Main Methods:
- Retrospective analysis of 90 patients undergoing two-stage VSD repair (PAB in infancy, total repair ~4 years old).
- Pulmonary artery reconstruction utilized pericardial patch, Dacron patch, or transverse angioplasty.
- VSD closure involved knitted Dacron patch (75 patients) or primary suture (13 patients); 2 had spontaneous closure.
Main Results:
- Overall mortality was 9% (8 patients), with causes including pulmonary hypertension, congestive heart failure, and atrioventricular block.
- Repeat catheterization in 20 patients showed no shunt in 16 and minimal shunt in 4.
- Residual pulmonary artery stenosis (2 patients) and infundibular stenosis (2 patients) were noted.
Conclusions:
- Two-stage surgical treatment for severely ill infants with VSD is a safe and reliable method.
- This approach demonstrates acceptable mortality rates and favorable long-term hemodynamic results.
- The study supports the efficacy of staged surgical management for complex VSD in early infancy.
Abstract:
Since 1964, 90 patients have undergone two-stage surgical repair of ventricular septal defect (VSD) with pulmonary artery banding (PAB) in early infancy and total repair at an average age of 4 years. Reconstruction of the pulmonary artery was accomplished with a pericardial patch, woven Dacron patch, or transverse angioplasty. The VSD was closed with a knitted Dacron patch in 75 patients and by primary suture technique in 13 patients. The VSD closed spontaneously in 2 patients. The mortality rate for patients who had repair and debanding was 9 per cent (8 patients), including 4 deaths due to severe pulmonary hypertensive disease, 3 from congestive heart failure, and one from atrioventricular block. Twenty patients underwent repeat cardiac catheterization several months to 7 years after total repair. This study revealed no shunt in 16 patients and a minimal shunt not requiring operation in the other 4 children. Slight residual stenosis of the pulmonary artery was found in 2 patients and a residual infundibular stenosis in another 2 patients. We believe two-stage surgical treatment of VSD in severely ill infants under one year of age is safe and reliable.
