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Restrictive ventricular septal defect: how small is too small to close?
C L Backer1, R C Winters, V R Zales
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, Illinois 60614.
The Annals of Thoracic Surgery
|November 1, 1993
Summary
Surgical closure of ventricular septal defects (VSDs) in children is safe and effective, with no deaths or major complications. These findings suggest reconsidering current VSD closure indications.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Historically, indications for ventricular septal defect (VSD) closure included heart failure, pulmonary hypertension, aortic insufficiency, and endocarditis.
- The risks of lifelong VSD versus surgical closure in asymptomatic children remain debated.
Purpose of the Study:
- To evaluate the safety and efficacy of elective VSD closure in children.
- To assess outcomes and complications associated with VSD closure.
Main Methods:
- A retrospective review of 141 patients aged 1-23 years who underwent VSD closure between 1980 and 1991.
- Patients had VSD closure if aged >1 year with a pulmonary to systemic flow ratio < 2.0.
Main Results:
- No early or late deaths or major morbidity were observed.
- No patient required a ventriculotomy; mean ICU and hospital stays were 1.3 and 5.5 days, respectively.
- No instances of atrioventricular dissociation, reoperations for bleeding, infections, or residual VSDs occurred.
Conclusions:
- Elective VSD closure in this cohort demonstrated excellent safety and low morbidity.
- Improved outcomes support reevaluating traditional indications for VSD closure.