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Flap valved closure of ventricular septal defects with increased pulmonary vascular resistance

Prasanna Simha Mohan Rao1, Varadaraju Raju, Madhusudana Narayana

  • 1Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Road, Bangalore, India. prasannasimha@gmail.com

Interactive Cardiovascular and Thoracic Surgery
|August 21, 2010
PubMed

Insights

Closure of large ventricular septal defects (VSDs) in children with severe pulmonary hypertension using a flap valve patch resulted in low mortality and reduced pulmonary artery pressures.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Pulmonary Hypertension

Background:

  • Elevated pulmonary vascular resistance (PVR) in children with ventricular septal defects (VSDs) poses significant surgical risks.
  • Pulmonary hypertensive (PH) episodes are a major concern following VSD closure in these high-risk patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of flap valved closure for large VSDs in children with severe PH.
  • To assess the impact of this technique on postoperative morbidity and mortality.

Main Methods:

  • Eighteen pediatric patients with large VSDs and severe PH (mean PVR > 8 Wood units) underwent flap valved closure.
  • The Novick et al. technique was employed, with patient age ranging from 3 to 13 years.

Main Results:

  • In-hospital 30-day mortality was 5.6% (1/18).
  • Average mechanical ventilation time was 11.6 ± 8.1 hours.
  • Postoperative pulmonary artery pressures were significantly reduced; however, four patients experienced PH crises.

Conclusions:

  • Flap valved closure of large VSDs in children with severe PH can be performed with acceptable morbidity and mortality.
  • The use of a flap valve patch appears to mitigate risks associated with VSD closure in this challenging patient population.

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