Optimal Therapeutic Strategy for Ventricular Septal Defect Closure in Extremely Preterm Infants with Chronic Lung...

Area of Science:

• Pediatric Cardiology
• Neonatology
• Congenital Heart Surgery

Background:

• Preterm infants with large ventricular septal defects (VSD), severe chronic lung disease (CLD), and pulmonary hypertension (PH) face hemodynamic instability after open-heart surgery.
• Clinical decision-making regarding initial pulmonary artery banding versus one-stage VSD closure is challenging due to a lack of established guidelines for this unique population.

Purpose of the Study:

• To report a successful case of pulmonary artery banding followed by VSD closure in an extremely preterm infant.
• To review existing literature on managing VSD with CLD and PH in preterm infants.

Main Methods:

• A case report of a preterm infant (23 weeks 4 days gestation, 540 g) with VSD, CLD, and PH treated with initial pulmonary artery banding and subsequent VSD closure.
• Literature review of similar cases in preterm infants with VSD, CLD, and PH.

Main Results:

• The infant successfully underwent pulmonary artery banding and later VSD closure, with pre-banding hemodynamics showing a pulmonary-to-systemic blood flow ratio of 2.5 and pulmonary vascular resistance of 2.6 U·m².
• Literature search identified five infants (including this case) with VSD, CLD, and PH; one underwent banding first and survived, while three underwent one-stage VSD closure with one mortality due to postoperative PH crisis.
• Three of the five reviewed infants required tracheostomy.

Conclusions:

• The choice between initial pulmonary artery banding and one-stage VSD closure requires careful case-by-case evaluation, considering the severity of VSD, CLD, and PH.
• Further registry studies are necessary to clarify the outcomes of these two surgical strategies in this high-risk population.