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Early surgical closure of a large ventricular septal defect: influence on long-term growth
1Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
Insights
Infants with large ventricular septal defects show significant growth deficits before surgery. Postoperative growth normalizes for those with normal birth weight, but low birth weight infants experience persistent growth issues.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Surgical Outcomes
Background:
- Large ventricular septal defects (VSDs) can impact infant growth.
- Early surgical intervention is common for significant VSDs.
Purpose of the Study:
- To evaluate pre- and postoperative growth patterns in infants undergoing VSD closure.
- To identify factors influencing long-term growth outcomes post-VSD repair.
Main Methods:
- Retrospective review of 52 infants with large VSDs undergoing primary surgical closure before 7 months.
- Serial measurements of weight, length, and head circumference were collected preoperatively and postoperatively.
- Growth parameters were expressed as Z scores and compared to reference populations and siblings.
Main Results:
- Preoperatively, all infants exhibited significantly below-normal weight, length, and head circumference Z scores.
- Long-term follow-up showed normal growth in infants with normal birth weight, comparable to siblings.
- Infants with low birth weight demonstrated persistent abnormal growth in all parameters compared to references and siblings.
Conclusions:
- Surgical closure of large VSDs can normalize growth in infants with adequate birth weight.
- Low birth weight is a significant predictor of persistent growth deficits after VSD repair.
- Further research into optimizing growth in low birth weight infants post-VSD surgery is warranted.
Abstract:
The pre- and postoperative growth patterns of 52 otherwise normal infants undergoing primary surgical closure of a large ventricular septal defect before 7 months of age were reviewed. Serial measurements of weight, length and head circumference were compiled for all patients preoperatively and in 46 long-term survivors and were expressed as Z scores (in standard deviations from the mean for age and gender). By the time of surgery at a mean age of 0.33 year, the mean weight, length and head circumference Z scores of all 52 infants were -2.9, -0.9 and -0.6, respectively, and were all significantly below normal (p less than 0.001). At a mean age of 5.7 years, the mean weight, length and head circumference Z scores of 35 patients of normal birth weight were normal or varied only marginally from those of the reference population (-0.4, -0.1 and +0.5, respectively; p less than 0.02, p greater than 0.05 and p = 0.008, respectively) and did not differ significantly in any variable from those of 44 normal siblings. However, among 11 infants with a low birth weight, all three variables remained abnormal at long-term follow-up when compared with the reference population (-1.7, -1.7 and -0.9, respectively; p less than 0.001 for each) and 22 normal siblings (p less than or equal to 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)