[Surgical treatment of ventricular septal defect in the first year of life]
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P Bastos1, R Nascimento, A R de Sousa
1Centro de Cirurgia Torácica, Faculdade de Medicina, Hospital de São João, Porto.
Insights
Early surgical closure of large ventricular septal defects (VSD) in infants is effective, with pulmonary artery banding as a palliative option in specific cases. This approach improves outcomes for infants with congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Intensive Care
Context:
- Large ventricular septal defects (VSD) pose significant risks to infants, often leading to failure to thrive and congestive heart failure.
- Surgical intervention is crucial for managing symptomatic infants with VSDs, but optimal timing and approach remain areas of study.
Purpose:
- To evaluate the outcomes of early primary surgical closure of large ventricular septal defects (VSD) in infants.
- To assess the efficacy of palliative pulmonary artery banding (PAB) as an alternative or initial strategy for VSD management in this population.
Summary:
- Forty-six infants with large VSDs underwent surgical treatment. Primary VSD closure was performed in 43 infants, with 7.0% early mortality and 2.3% incidence of heart block. Late follow-up showed no mortality, prompt relief of heart failure, and specific conduction abnormalities.
- Three infants received palliative pulmonary artery banding (PAB) with no mortality. Subsequent VSD closure and debanding in two patients were also successful, with no complications related to the band.
Impact:
- Early primary closure of VSDs is confirmed as the preferred treatment for symptomatic infants.
- Pulmonary artery banding (PAB) offers a viable palliative option in select circumstances, demonstrating successful outcomes when followed by VSD correction.
Abstract:
Forty six infants with a large ventricular septal defect (VSD) underwent surgical treatment during the first 12 months of life. Forty three patients ranging in age from 3 to 12 months (mean age 10.4 months) and weighting from 3.0 to 8.2 kg (mean weight 6.8 kg) had primary surgical closure of their VSD. All infants were below the third percentile for weight preoperatively. In 40 patients (93%) the defect was closed through the right atrium. Three patients (7.0%) died in the early postoperative period. Surgically induced heart block occurred in one patient (2.3%). Late results were assessed in 29 surgical survivors (mean follow-up 26 months). There was no late mortality. Relief of congestive heart failure was prompt in all patients following closure of VSD. Right bundle branch block with left anterior hemiblock developed in 5 patients (17.2%), and right bundle branch block alone in 10 patients (34.5%). Three patients (mean age 4.3 months, mean weight 2.7 kg) underwent initial palliative pulmonary artery banding (PAB). There were no operative or late mortality. Closure of VSD and pulmonary artery debanding was performed in two of these patients, with no mortality. Prior to intracardiac correction the pulmonary artery pressure distal to the band was normal; no band related complications were found. Early primary closure is the treatment of choice for symptomatic infants with large VSDs. In particular circumstances, however, PAB may provide effective palliation.