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Congestive heart failure during early infancy in patients with ventricular septal defect relative to early closure
1Department of Pediatrics, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka 812, Japan.
Insights
Infants with large left-to-right shunts from ventricular septal defects (VSD) often require early surgery. Right ventricular volume overload, indicated by shunts through the VSD and patent foramen ovale, predicts the need for prompt intervention.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Hemodynamics
Background:
- Ventricular septal defects (VSD) are common congenital heart abnormalities.
- Early surgical closure of VSD is crucial for managing hemodynamic instability in infants.
- Understanding shunt characteristics guides timely surgical intervention.
Purpose of the Study:
- To evaluate hemodynamic features in infants with VSD requiring surgical closure.
- To correlate shunt size and timing of VSD closure.
- To identify indicators of large shunts in early infancy.
Main Methods:
- Retrospective analysis of 44 infants undergoing VSD surgical closure.
- Comparison of hemodynamic parameters between early (<6 months) and later (6-12 months) closure groups.
- Assessment of left-to-right (L-R) shunts, ventricular volumes, and oxygen saturation step-ups.
Main Results:
- Significantly greater L-R shunts were observed in the early closure group (Group A).
- Higher right atrial oxygen saturation step-up in Group A indicated L-R shunting across a patent foramen ovale (PFO).
- Diastolic L-R shunting through the VSD was confirmed angiographically in all patients.
Conclusions:
- Larger L-R shunts in early infantile VSD correlate with the likelihood of early surgical intervention.
- Right ventricular volume overload, from shunts via VSD and PFO, is a key indicator of significant shunting in infants.
- Hemodynamic assessment aids in determining the urgency of VSD repair.
Abstract:
The hemodynamic features of 44 patients requiring surgical closure of a ventricular septal defect (VSD) during early infancy were evaluated. The VSD was closed within the first 6 months of life in 29 patients (group A) and during the second 6 months in 15 patients (group B). The left-to-right (L-R) shunts were significantly greater in group A than in group B, although in all patients they were more than 50%. In contrast, the left ventricular end-diastolic volume was significantly greater in group B than in group A, whereas the right ventricular end-diastolic volume was greater in group A; the difference was not statistically significant. The step-up in blood oxygen saturation in the lower right atrium, which was significantly more in group A, indicated the L-R shunt across the patent foramen ovale (PFO). The L-R shunt across the VSD during diastole was also detected in all patients angiographically. With early infantile VSD, the larger the L-R shunt the greater was the likelihood of early surgery. Right ventricular volume overload caused by the L-R shunt across a PFO as well as through the VSD during diastole is a useful indicator of a large shunt in infants with VSD.