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Surgical management of ventricular septal defect in infancy
Insights
Surgical repair of symptomatic ventricular septal defects in infants can be achieved through a two-stage approach or primary repair. The two-stage method, involving pulmonary artery banding followed by closure, shows improved outcomes in critically ill infants.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Surgical Outcomes
Background:
- Symptomatic ventricular septal defects (VSDs) in infants often necessitate surgical intervention when medical therapy fails.
- Surgical strategies for VSDs include staged procedures and primary intracardiac repair.
Purpose of the Study:
- To compare the surgical outcomes of a two-stage approach (pulmonary artery banding followed by debanding and VSD closure) versus primary intracardiac repair in infants with VSDs.
Main Methods:
- Retrospective review of infants with symptomatic VSDs undergoing surgical repair.
- Comparison of operative mortality rates between the two-stage repair and primary repair groups.
Main Results:
- The initial cohort of 36 infants undergoing pulmonary artery banding had a 5.6% operative death rate.
- In the two-stage repair group, 18 patients had a 25.6% operative death rate (1971-1979), but this decreased to 0% in 10 patients during 1978-1979.
- Primary intracardiac repair in nine infants during 1978-1979 resulted in a 33.3% operative death rate.
Conclusions:
- The two-stage surgical approach for symptomatic ventricular septal defects in critically ill infants demonstrates potential for improved outcomes, particularly with recent refinements.
- Further investigation into optimizing staged surgical strategies for complex VSDs is warranted.
Abstract:
Symptomatic ventricular septal defects in infants who responded poorly to intensive medical therapy require surgical intervention. This paper aims to compare the results of the two stage approach of initial pulmonary artery banding followed by debanding and ventricular septal defect closure with primary intracardiac repair in infancy. Thirty-six infants underwent pulmonary artery banding between 1968-1979 with two operative deaths (5.6%). Eighteen patients underwent pulmonary artery debanding and closure of ventricular septal defect between 1971-1979 with five operative deaths (25.6%). However during 1978-1979 ten patients underwent 2nd stage repair with no operative death. During the same period primary intracardiac repair in infancy was carried out in nine infants with three operative deaths (33.3%). There appears to be still a place for two stage treatment of symptomatic ventricular-septal defect in critically ill infants certain situation.