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Published on: February 8, 2022
Long-term results of primary closure for ventricular septal defects in the first year of life
R Kuribayashi1, S Sekine, H Aida
1Department of Cardiovascular Surgery, Akita University School of Medicine, Japan.
Insights
Primary closure of large ventricular septal defects (VSDs) in infants under one year old shows excellent long-term results. This early surgical intervention leads to normal growth and good quality of life for survivors.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
Background:
- Large Ventricular Septal Defects (VSDs) in infants present significant challenges.
- Early intervention is crucial for long-term outcomes in pediatric heart conditions.
Purpose of the Study:
- To evaluate the long-term results of primary VSD closure in infants under one year old.
- To assess the efficacy and safety of early surgical repair for severe VSDs.
Main Methods:
- Retrospective analysis of 49 infants undergoing primary VSD closure between 1971 and 1982.
- Surgical technique involved right ventriculotomy, cardiopulmonary bypass, and mild hypothermia.
- Long-term follow-up exceeding 10 years included clinical assessment and cardiac catheterization.
Main Results:
- Low hospital mortality (4 deaths) and no late deaths observed.
- Significant reduction in cardiothoracic ratio and pulmonary-to-systemic pressure ratio (Pp/s).
- Survivors demonstrated normal growth, good quality of life, and improved cardiac function (ejection fraction 64.4%).
Conclusions:
- Primary VSD repair in the first year of life is recommended for infants with large VSDs.
- Early surgical intervention leads to favorable long-term outcomes and improved quality of life.
- The study supports the benefits of timely surgical management for congenital heart defects.
Abstract:
The long-term results of primary closure for large ventricular septal defects (VSDs) in infants under 1 year of age with severe symptoms were studied over a period of more than 10 years. Between January, 1971 and March, 1982, 49 infants underwent primary closure of a VSD through a right ventriculotomy using complete cardiopulmonary bypass with mild hypothermia. There were four hospital deaths but no late deaths. Two of four infants with residual shunts had a left ventricular-right atrial shunt which necessitated reoperation. Surgical heart block occurred in two infants who recovered sinus rhythm in the late period. The cardiothoracic ratio decreased from 60.5% preoperatively to 50.6% in the late postoperative period. Examination by cardiac catheterization revealed that the pulmonary-to-systemic pressure ratio (Pp/Ps) of 23 patients with a Pp/Ps of over 0.75 fell from 0.89 +/- 0.09 preoperatively to 0.42 +/- 0.12 by 1 month postoperatively, then to 0.27 +/- 0.05 in the late postoperative period. The latest values for the cardiac index and left ventricular ejection fraction were 3.4 l/min per m2 and 64.4%, respectively. More than 10 years after their operation, all the survivors were growing normally and maintaining a good quality of life, which supports our recommendation that primary repair should be performed in the first year of life for infants with large VSDs.
