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[Treatment of ventricular septal defects with pulmonary hypertension in infancy (author's transl)]
Insights
Early surgery for infants with ventricular septal defects and pulmonary hypertension significantly improves outcomes. Optimal timing, especially between 6-12 months for single defects, minimizes mortality and residual complications.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Neonatal Medicine
Context:
- Ventricular septal defects (VSD) are common congenital heart abnormalities.
- Pulmonary hypertension (PH) in infants with VSD poses significant risks.
- Early surgical intervention is a critical management strategy.
Purpose:
- To evaluate the outcomes of early surgical treatment for infants with VSD and PH.
- To determine the optimal timing for surgical intervention.
- To assess the risk of residual pulmonary hypertension after surgery.
Summary:
- A study of 188 infants with VSD and PH showed an overall mortality rate of 10%, reduced to 6% since 1979 and 0% for single defects operated on between 6-12 months.
- Excellent surgical results were observed in 48 cases operated on within the first year of life.
- Delayed surgery increased the risk of residual pulmonary hypertension, particularly in cases with equal pressure levels.
Impact:
- Early surgical intervention for VSD with PH can lead to excellent outcomes.
- Timing of surgery is crucial, with a recommendation for intervention in the second half of life for severe PH.
- Infants unresponsive to medical treatment require surgical consideration to prevent adverse outcomes.
Abstract:
188 infants presenting with ventricular septal defects associated with pulmonary hypertension underwent early surgical treatment. Overall death rate was 10% (6% since 1979 and even 0% in case of single defects operated on between the ages of 6 and 12 months). Surgical results were excellent in 48 controlled cases operated on during the 1st year of life. When surgery was performed later, risk of residual pulmonary hypertension remained in cases with equal pressure levels. Our results suggest that all the infants who do not respond properly to medical treatment must be operated on and that those with a major pulmonary hypertension have to be operated on during there second semester of life.