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Valve patch technique for repair of ventricular septal defect: long-term results
Abbas Afrasiabirad1, Mahmoud Samadi1, Parisa Vatani1
1Cardiovascular Research Center, 48432Tabriz University of Medical Sciences, Tabriz, Iran.
Insights
Unidirectional valve patch repair for ventricular septal defect with pulmonary artery hypertension shows improved outcomes in survivors. Despite risks, surgery offers better functional class and quality of life for many patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Pulmonary Hypertension
Background:
- Ventricular septal defect (VSD) with pulmonary artery hypertension (PAH) presents significant surgical challenges.
- Unidirectional valve patch repair is a surgical option for this complex condition.
- Long-term outcomes for VSD repair in patients with PAH require further investigation.
Purpose of the Study:
- To evaluate the long-term results of unidirectional valve patch repair in patients with VSD and PAH.
- To assess the impact of surgery on pulmonary artery pressure and functional status.
- To determine the safety and efficacy of this surgical approach in a challenging patient cohort.
Main Methods:
- Retrospective review of 35 acyanotic patients (age 2-26 years) with large VSD and elevated pulmonary vascular resistance.
- Surgical repair using unidirectional valve patch technique.
- Long-term follow-up (mean 11 years) assessing clinical outcomes, functional class, and echocardiographic parameters.
Main Results:
- Early mortality was 14.3% (5/35).
- In long-term follow-up, 17 patients showed gradual decrease in pulmonary artery hypertension with improved functional class and reduced tricuspid regurgitation.
- Survivors with persistent PAH had varied outcomes, with some showing satisfactory condition and others developing right heart failure.
Conclusions:
- Unidirectional valve patch repair can lead to improved long-term functional status in survivors with VSD and PAH.
- Persistent pulmonary artery hypertension should not be a contraindication for surgical intervention.
- Careful patient selection and management are crucial for optimizing outcomes in this high-risk group.
Objective:
This study aimed to show the long-term results in patients who underwent unidirectional valve patch repair of ventricular septal defect with pulmonary artery hypertension.
Methods:
Thirty-five acyanotic patients aged 2 to 26 years (mean 9.3 years) with a large ventricular septal defect and elevated pulmonary vascular resistance (mean 9.5 Wood units) underwent surgery in Madani Heart Hospital. The medical records and clinical outcomes were reviewed from March 1998 to March 2017.
Results:
Five patients died in the first postoperative week. In the long-term follow-up (mean 11 years), two patients were lost to follow-up. Pulmonary artery hypertension gradually decreased in 17 patients within 6-12 months with significant improvement in right ventricular end-diastolic diameter, New York Heart Association functional class, and tricuspid regurgitation. Eleven patients with persistent pulmonary artery hypertension were divided into tolerable and non-tolerable groups. Six patients in the tolerable group had satisfactory conditions compared to before the operation, and gained weight with improved functional class despite echocardiographic findings of persistent elevated pulmonary artery pressure. One had a full-term delivery by caesarean section in the fifth postoperative year. Five patients in the non-tolerable group gradually developed right heart failure and complications such as extremity edema, ascites, pleural effusions, and died after 10-30 months.
Conclusion:
Although relatively high mortality occurred during long-term follow-up, surviving patients were in a better condition and functional class despite persistent pulmonary artery hypertension. Therefore, fear of persistent pulmonary artery hypertension should not prohibit surgery in this group of patients.
