Surgical closure of ventricular septal defect in the first year of life: forty-three consecutive successful cases
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K Haneda1, E Ishizawa, S Yamaki
1Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, Sendai.
Insights
Surgical closure of ventricular septal defects (VSD) in infants under 12 months showed no operative mortality. Early surgical intervention for refractory VSD leads to satisfactory outcomes and body weight gain.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
Background:
- Ventricular septal defects (VSD) are common congenital heart anomalies requiring timely intervention.
- Evaluating surgical outcomes in infants with VSD is crucial for guiding treatment strategies.
Observation:
- Forty-three infants under 12 months underwent VSD closure between 1982 and 1987.
- Associated cardiac anomalies included patent ductus arteriosus (PDA), atrial septal defect (ASD), and pulmonary stenosis (PS).
- Surgical techniques involved hypothermia with circulatory arrest or standard cardiopulmonary bypass.
Findings:
- VSD closure was performed without operative mortality, with an average patient age of 6.9 months.
- Postoperative pulmonary to systemic pressure ratio (Pp/Ps) significantly decreased from 0.79 to 0.39.
- Most patients experienced satisfactory body weight gain following VSD repair.
Implications:
- Aggressive early surgical management of refractory VSD in infants is supported by these findings.
- Successful VSD closure promotes improved physiological parameters and growth in young children.
- This study highlights the efficacy of surgical VSD repair in improving long-term infant health.
Abstract:
Forty-three infants (less than 12 months of age) underwent VSD closure without operative mortality between June 1982 and December 1987. Average age and body weight at the operation were 6.9 months and 5.3 kg, respectively. Associated cardiac anomalies were PDA (11 patients), ASD (5) and PS (1). Preoperative pulmonary to systemic peak pressure ratio (Pp/Ps), resistance ratio and flow ratio, and pulmonary vascular resistance were 0.79 +/- 0.15, 0.29 +/- 0.16, 2.52 +/- 0.60 and 3.05 +/- 1.94 unit.m2, respectively. VSD was closed under combined surface/perfusion hypothermia with total circulatory arrest in 25 patients and standard cardiopulmonary bypass in 18. All patients were discharged from the hospital in good condition, but there was one late death due to pneumonia. Postoperative Pp/Ps decreased to 0.39 +/- 0.11. Most of the patients demonstrated satisfactory body weight gain after VSD closure. These results support our current policy of aggressive surgical intervention for refractory VSD in the early stage of life.