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Surgical correction of ventricular septal defects in black and white children--an 11-year study
Insights
Black children experienced more severe clinical presentations of ventricular septal defects (VSDs), including higher rates of infections and heart failure. However, surgical outcomes for VSD closure were comparable across ethnic groups, with perimembranous defects being most common.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Ventricular septal defects (VSDs) are common congenital heart anomalies.
- Understanding ethnic variations in VSD presentation and outcomes is crucial for equitable care.
Purpose of the Study:
- To analyze clinical features, anatomical subtypes, and outcomes of VSD surgical closure in black and white children.
- To compare the severity of presentation and surgical results between ethnic groups.
Main Methods:
- Retrospective review of 309 children undergoing VSD surgical closure.
- Analysis of clinical data, cardiac catheterization findings, ECG, and operative outcomes.
- Stratification by race (black vs. white) and age at surgery.
Main Results:
- Black children presented with more severe symptoms, including higher rates of recurrent pulmonary infections (65% vs. 34%) and congestive cardiac failure (60% vs. 37%).
- Left-to-right shunts and severe pulmonary hypertension were similarly distributed across ethnic groups.
- Perimembranous VSD was the most frequent anatomical subtype (65% in both groups), with no significant ethnic difference in other subtypes or Left Axis Deviation (LAD) on ECG.
- Early mortality was higher in black children (7.1%) compared to white children (3.6%), with severe pulmonary hypertension being a key factor in fatal cases.
Conclusions:
- Surgical results for VSD closure in this cohort were favorable and comparable to international standards.
- Anatomical VSD subtypes and ECG findings, including LAD, occurred with similar frequency in black and white children.
- LAD on ECG was strongly associated with perimembranous VSD.
Abstract:
The clinical and ECG features, anatomical subtypes and outcome in 309 children (169 black; 140 white; 58% female) who underwent surgical closure of ventricular septal defects (VSDs) are presented. Clinical presentation was more severe in the black children; with recurrent pulmonary infections in 65% blacks compared with 34% whites. Congestive cardiac failure was noted in 60% blacks and in 37% whites. At cardiac catheterisation a left to right shunt greater than 2.5/1 was found in 45.5% of the black and in 39.3% of the white children. Severe pulmonary hypertension (greater than 80% of systemic systolic pressure) was evenly distributed in both groups. Of the 140 white children, 74.3% underwent surgery under the age of 2 years compared with 68.6% of the 169 blacks. A perimembranous VSD was found in 65% of patients in each group. Infundibular (muscular outlet) defects were observed in 28.6% of white and 30.8% of black children. Left axis deviation (LAD) on ECG was found in 11.9% of white and 9.2% of black patients; and 93% of the total of 27 cases had a perimembranous defect. Early mortality was 3.6% in white and 7.1% among the black children. Of the 17 fatal cases in the total group, 16 had severe pulmonary hypertension. It is concluded that: (i) operative results compared favourably with those reported elsewhere; (ii) the anatomical subtypes occurred with equal frequency in both ethnic groups; and (iii) this was also the case for LAD on ECG, which was most commonly associated with a perimembranous VSD.