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Primary surgical closure of large ventricular septal defects in small infants
J T Hardin1, A D Muskett, C E Canter
1Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Insights
Primary surgical closure of large ventricular septal defects (VSDs) in infants is safe and effective, regardless of weight. Early repair in smaller infants shows comparable outcomes to larger ones, eliminating the need for delayed procedures.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Medicine
Background:
- Large ventricular septal defects (VSDs) often necessitate surgical intervention in infants.
- Traditional approaches sometimes delay repair until infants reach a certain weight.
- Concerns exist regarding the safety of early VSD closure in smaller infants.
Purpose of the Study:
- To evaluate the outcomes of primary surgical closure of large VSDs in infants based on weight.
- To compare mortality and complication rates between infants weighing 4 kg or less and those weighing more than 4 kg.
- To determine if delayed surgical repair is necessary for infants with VSDs.
Main Methods:
- Retrospective review of 48 infants with large VSDs undergoing primary surgical closure.
- Infants divided into two groups: Group 1 (≤4 kg) and Group 2 (>4 kg).
- Comparison of early mortality, late mortality, and major complication rates between the two groups.
Main Results:
- No early deaths in Group 1 (≤4 kg) versus 1 death (4%) in Group 2 (>4 kg).
- Similar rates of major complications in both groups (9% vs. 12%).
- Two late deaths (9%) in Group 1, none in Group 2; no patient required reoperation.
Conclusions:
- Primary surgical closure of large VSDs, including multiple muscular types, is safe and effective in very small infants.
- Outcomes are comparable to those in larger infants, negating the need for delayed repair or palliative banding.
- Early intervention for large VSDs in infants is a viable and recommended strategy.
Abstract:
Herein, a policy of primary surgical closure of large ventricular septal defects in infants is reviewed. Forty-eight infants met criteria for inclusion in the study, and were divided into two groups based on weight: group 1 infants weighted 4 kg or less (n = 23), and group 2 infants weighed more than 4 kg (n = 25). Both groups had similar variation in ventricular septal defect location (paramembranous versus muscular) and number (single versus multiple), as well as incidence of major associated extracardiac diseases. No early deaths occurred in group 1, compared with 1 infant (4%) in group 2. Major complications occurred similarly in both groups (9% versus 12%). There were two late deaths in group 1 (9%) and none in group 2. No surviving patients have required a second ventricular septal defect operation, and the majority no longer receive anticongestive therapies. These results indicate that primary surgical closure of large ventricular septal defects, even multiple muscular defects, can be performed in very small infants with no difference in mortality or serious complication rates compared with larger infants. Protracted medical efforts to achieve larger size before primary repair and palliative pulmonary artery banding are not necessary.