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Deep hypothermia with reduced flow rates for correction of ventricular septal defects in infants. An alternative
Insights
This study reports successful surgical correction of large ventricular septal defects (VSD) in infants using deep hypothermia (DH) and reduced flow rates. The technique ensured excellent myocardial protection, with a low hospital mortality of 5%.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hypothermia in Medicine
Background:
- Large ventricular septal defects (VSD) with pulmonary hypertension pose significant surgical challenges in infants.
- Current surgical strategies require effective myocardial protection during cardiopulmonary bypass.
Purpose of the Study:
- To report the experience of correcting large VSD in infants using deep hypothermia (DH) and reduced flow rates.
- To evaluate the efficacy and safety of this technique in pediatric cardiac surgery.
Main Methods:
- Sixty infants (1.5-12 months) with VSD and pulmonary hypertension underwent surgical repair.
- Deep hypothermia (18°C rectal temperature) with reduced pump flow (0.28 L/min/m²) was employed during intracardiac repair.
- Xenopericardial patches were used for VSD closure; additional procedures included patent ductus arteriosus ligation and atrial septal defect repair.
Main Results:
- Hospital mortality was 5% (3 out of 60 patients).
- Spontaneous cardiac rhythm restoration occurred during rewarming in all cases.
- Postoperative cardiac index (48 hours) ranged from 2.5-4.2 L/min/m², with extubation between 18-44 hours.
Conclusions:
- Deep hypothermia with reduced flow rates offers excellent myocardial protection and surgical exposure for VSD repair in infants.
- This technique is safe and effective, associated with favorable early postoperative outcomes.
Abstract:
In this presentation our experience of the correction of large ventricular septal defects (VSD) under deep hypothermia (DH) and reduced flow rates in infants is reported. Sixty patients with VSD and pulmonary hypertension were operated. The age of the patients varied from 1.5 to 12 months and body weight from 3.0 to 8.7 kg. Deep hypothermia was achieved by cooling the patient using a heart-lung machine after aortic and right atrial cannulation. At a rectal temperature of 18 degrees C, pump flow was reduced to 0.28 l . min-1 . m-2 and cardiotomy was performed. Venous blood from the right atrium was aspirated with a single coronary sucker. The aorta was not clamped. After completion of the intracardiac repair, pump flow was increased and the patient was rewarmed to a rectal temperature of 36 degrees C. In all cases cardiac rhythm was restored spontaneously during rewarming. In every patients, the VSD was closed with a xenopericardial patch (in 42 patients from a right atrial approach and in 18 patients through the ventriculotomy). In 5 patients a patent ductus was also ligated and in 37 patients an atrial septal defect was sutured. The hospital mortality was 5% (3 patients). In the remaining 57 patients the cardiac index during the first 48 hours after operation was 2.5-4.2 l . min-1 . m-2. Patients were extubated between 18 and 44 hours after the operation. Deep hypothermia with reduced flow rates during intracardiac repair provides excellent myocardial protection and exposition in infants with VSD.