Ventricular septal defect: results after repair in infancy

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery

Background:

• Large ventricular septal defects (VSDs) often lead to severe pulmonary hypertension or heart failure in infants.
• Surgical outcomes for VSD repair in very young children have historically been a concern.

Purpose of the Study:

• To evaluate the long-term outcomes of early surgical repair for large VSDs in patients under two years of age.
• To compare the results of early VSD repair with those of later surgical intervention.

Main Methods:

• Retrospective analysis of 106 patients under two years old who underwent VSD repair between 1957 and 1975.
• Assessment of operative mortality, long-term complications, symptomatic improvement, growth patterns, and hemodynamic status via cardiac catheterization.

Main Results:

• Eighty-three infants survived surgery, with one late death. Mortality was highest in infants under six months and those with severe pulmonary hypertension.
• Surviving patients demonstrated significant symptomatic improvement and enhanced growth.
• Approximately 50% experienced conduction abnormalities (right bundle branch block, left anterior hemiblock), with one case of complete atrioventricular block.
• Postoperative pulmonary arterial pressures and resistance ratios were generally normal, contrasting with outcomes in older patients.
• Of 45 patients catheterized postoperatively, 17 had residual defects, but only 3 required reoperation due to significant shunting.

Conclusions:

• Early surgical repair of large VSDs in infants is associated with favorable long-term outcomes and significant clinical benefits.
• While surgical complications exist, they are comparable to those in older patients, and early intervention maximizes therapeutic advantages.
• The study highlights the importance of timely surgical management for large VSDs to improve patient growth and reduce long-term cardiovascular sequelae.