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Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension
Sachin Talwar1, Shiv Kumar Choudhary, Sanket Garg
1Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. sachintalwar@hotmail.com
Insights
Unidirectional valved patch (UVP) closure effectively treats large ventricular septal defects (VSD) with severe pulmonary arterial hypertension (PAH). This technique offers a promising solution, reducing complications and improving patient outcomes in developing countries.
Area of Science:
- Cardiology
- Pediatric Surgery
- Pulmonary Hypertension
Background:
- Delayed presentation of large ventricular septal defects (VSD) is prevalent in developing nations.
- Patients with VSD often develop severe pulmonary arterial hypertension (PAH), leading to increased surgical risks.
Purpose of the Study:
- To evaluate the efficacy of a unidirectional valved patch (UVP) technique for VSD closure in patients with severe PAH.
- To assess the safety and outcomes of UVP closure in this high-risk population.
Main Methods:
- Seventeen patients (age 2-23 years) with large VSD and severe PAH underwent VSD closure using the UVP technique between 2006 and 2010.
- Pre-operative assessments included pulmonary vascular resistance (PVRI) and systemic oxygen saturation.
- Intra-operative and post-operative echocardiography monitored shunt status and recovery.
Main Results:
- No in-hospital deaths occurred, and all patients experienced uneventful recovery.
- Post-operative follow-up (mean 30 months) showed no shunt across the patch and systemic saturation >95% in all patients.
- Three younger patients (2, 7, 9 years) with high pre-operative PVRI showed transient right-to-left shunting intra-operatively, which resolved.
Conclusions:
- Unidirectional valved patch (UVP) closure is a safe and effective technique for managing large VSDs with severe PAH.
- UVP offers a promising surgical option for patients in developing countries facing delayed VSD presentation and associated complications.
Abstract:
Delayed presentation of ventricular septal defect (VSD) is common in developing countries. Such patients often have severe pulmonary arterial hypertension (PAH), which increases post-operative morbidity and mortality. To address these problems, we used our technique of unidirectional valved patch (UVP) for closure of VSD. Between January 2006 and December 2010, 17 patients (age 2-23 years, median 9 years) with a large VSD and severe PAH underwent VSD closure with UVP. Pre-operative mean indexed pulmonary vascular resistance (PVRI) was 10.9 ± 2.2 Wood units and mean pre-operative systemic saturation was 93.4 ± 2.6%. Shunt was bidirectional in 15 patients and predominantly right to left in two. After VSD closure, intra-operative transoesophageal echocardiography revealed a right to left shunt across the patch in three patients 2, 7 and 9 years of age who had pre-operative PVRI of 9.5, 9.8 and 11.1 Wood units, respectively. There were no in-hospital deaths and all patients had uneventful recovery. Mean follow-up was 30 ± 14.7 months and all patients are well without cyanosis. Echocardiography showed no shunt across the patch and all have systemic saturation >95%. We conclude that UVP is a promising technique in patients with large VSD and severe PAH.
