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[Echocardiographic assessment of interventricular septal defect corrected during the first year of life]
R Nascimento1, P Bastos, S Torres
1Unidade de Cardiologia Pediátrica, Hospital de S. João, Porto.
Insights
Surgical closure of perimembranous ventricular septal defects (VSD) in infants is safe and effective. Echocardiography provides comprehensive noninvasive assessment, reducing the need for cardiac catheterization.
Area of Science:
- Cardiology
- Pediatric Surgery
- Medical Imaging
Background:
- Perimembranous ventricular septal defects (VSD) are common congenital heart abnormalities requiring surgical intervention.
- Early surgical closure aims to prevent long-term complications and improve cardiac function.
- Echocardiography is a key noninvasive tool for evaluating cardiac structure and function.
Purpose of the Study:
- To assess the medium-term outcomes of surgical VSD closure in infants.
- To evaluate left ventricular (LV) systolic function post-surgery using echocardiography.
- To detect residual defects, valve regurgitation, and estimate pulmonary pressures.
Main Methods:
- Prospective study of 29 infants undergoing VSD closure within the first year of life.
- Postoperative follow-up using echocardiography for up to 60 months.
- Comparison of LV systolic function parameters (shortening fraction, PET/ET ratio) with a control group.
Main Results:
- Significantly different LV shortening fraction and PET/ET ratio compared to controls.
- 17% of patients had small residual VSDs; 7% had mild aortic regurgitation.
- Trivial to mild tricuspid regurgitation was common (79%); RVSP ranged from 30-45 mmHg.
Conclusions:
- Surgical closure of perimembranous VSD in infancy is feasible with good outcomes.
- Echocardiography offers a complete noninvasive evaluation of cardiac status post-VSD repair.
- This approach minimizes the need for invasive postoperative cardiac catheterization.
Objective:
To evaluate the medium term results of surgical closure of ventricular septal defect (VSD) performed during the first year of life, using echocardiography (echo).
Material And Methods:
We studied prospectively 29 patients aged from 17 to 68 months (mean = 37) who underwent surgical closure of perimembranous VSD during the first year of life. The postoperative follow-up time ranged from 6 to 60 months (mean = 26). Fifteen age-matched normal children were used as a control group in evaluating the left ventricular (LV) systolic function. The echo study included: 1) the assessment of LV systolic function using the shortening fraction, ejection fraction, pre-ejection to ejection time ratio (PET/ET), aortic flow acceleration time, acceleration to ejection time ratio, mean aortic flow acceleration; 2) detection and quantification of residual VSD as well as tricuspid and or aortic regurgitation; 3) determination of right ventricular systolic pressure (RVSP). The RVSP was evaluated from the maximum flow velocity from a residual VSD or tricuspid regurgitation, using the simplified Bernoulli equation.
Results:
The LV systolic function parameters from patients versus (vs) normals showed a significantly different shortening fraction (34 +/- 5 vs 39 +/- 4; p = 0.005) and PET/ET ratio (0.34 +/- 0.04 vs 0.31 +/- 0.03; p = 0.02). None of the other studied parameters was significantly different from normal. Five (17%) patients had a small residual VSD. Two (7%) patients had mild aortic regurgitation. Tricuspid regurgitation was detected in 23 (79%) patients being trivial in 20 and mild to moderate in 3. The RVSP was quantified in 22 (76%) patients, ranging from 30 to 45 mmHg (mean +/- SD = 36 +/- 4). None of the remaining 7 patients showed changes in the end-systolic interventricular septal configuration.
Conclusions:
Our study shows that surgical closure of perimembranous VSD performed during the first year of life was possible without significant mobility. Furthermore, the echo allowed a complete and noninvasive cardiac evaluation of the anatomic, functional and hemodynamic status of this group of patients, thus limiting the need for postoperative control cardiac catheterization.