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Repair of large ventricular septal defects in infants and small children
Insights
Primary repair of large ventricular septal defects in infants offers excellent outcomes. This surgical approach for severely symptomatic children resulted in significant improvement and minimal long-term complications.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Research
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Surgical intervention is often necessary for severely symptomatic infants with large VSDs.
- The optimal surgical strategy for VSD closure in infants remains an area of interest.
Purpose of the Study:
- To evaluate the efficacy and outcomes of primary repair for large isolated ventricular septal defects in infants and children.
- To assess the safety and long-term results of this surgical approach.
Main Methods:
- A retrospective analysis of 32 infants (1-24 months) with large VSDs undergoing primary repair.
- Surgical closure was predominantly performed via the right atrium.
- Patient outcomes were assessed through clinical follow-up and repeat catheterization.
Main Results:
- One hospital death (3%) occurred in the cohort.
- Most survivors showed remarkable improvement, maintaining New York Heart Association Class I or II status at a 4-year follow-up.
- Postoperative pulmonary vascular resistance was generally normal or minimally elevated, with elimination of significant left-to-right shunts in most cases.
Conclusions:
- Primary repair of large ventricular septal defects in infants is a safe and effective surgical option.
- This approach leads to excellent long-term functional outcomes for the majority of patients.
- The findings support the continued practice of primary VSD repair in select pediatric populations.
Abstract:
It is possible to achieve excellent results for primary closure of ventricular septal defects regardless of the age of the patients when surgical intervention is required. Thirty-two severely symptomatic patients, age 1-24 months, with large ventricular septal defects (m Qp/Qs = 3.4, m R VSD = 4.0), had primary repair of the defects with one (3%) hospital death. Seven patients (22%) had increased pulmonary vascular resistance ranging from 5.4 to 12 units/m2. It was possible to close the ventricular septal defect through the right atrium in 26 patients (81%). Pulmonary artery banding was not performed in any patient with isolated ventricular septal defect during the period of this study. The 31 survivors have been followed an average of four years, and 30 of them are remarkably improved and remain New York Heart Association Class I or II. Only one patient, with obstructive pulmonary vascular disease (pulmonary resistance = 12 U/m2), died suddenly 16 months after operation. Follow-up catheterization was offered to all patients, and to date, 18 (60%) have been restudied. These hemodynamic data show that pulmonary vascular resistance after surgery is usually normal or only minimally elevated; except for one patient with a large residual ventricular septal defect, functionally significant left to right shunts were eliminated. These results and the analysis of results of combined series reported in the literature for primary and staged operations for the continued practice of primary repair of isolated large ventricular septal defects in infants and children who require surgery.