The outlook for children after cardiac surgery: ventricular septal defects

The indications for and results of surgical closure of ventricular septal defect (VSD), uncomplicated by other congenital cardiac defects, depend on the size of the VSD and its haemodynamic consequences. In infants the timing of surgical closure is determined largely by the persistence of symptoms of congestive cardiac failure unresponsive to maximal medical treatment. There is a high incidence of spontaneous closure of VSD with age, especially in defects of small size. Accompanying aortic regurgitation is a serious complication. Progress in surgical technique (e.g. deep hypothermia, cardioplegia, identification of the conduction tissue) has substantially decreased the hospital mortality of surgical closure and the incidence of late deaths. In selected series the hospital mortality has been reduced to as low as 1-2% in patients over one year of age. Unless there is intractable cardiac failure (rarely observed beyond infancy), surgical closure can be delayed: pulmonary vascular obstructive disease develops only very exceptionally below the age of two years. Late complications include re-opening of the patch repair, arrhythmias and conduction disorders. The prognosis of post-operative left axis deviation plus right bundle branch block (left anterior hemiblock) is good in the absence of serious arrhythmias. Late deaths are rare. Operation in early childhood prevents the occurrence or persistence of abnormal right ventricular function. Exercise tolerance is normal in the absence of complications in practically all patients, who can therefore lead a normal life in all respects. There is, however, still slight doubt to what extent surgical closure is truly "curative" rather than "corrective".