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Early and late results of closure of ventricular septal defect in infancy
Insights
Patch closure of ventricular septal defects (VSD) in infants is effective, even in those under three months or below the third percentile for weight. This surgical approach shows promising outcomes with no late mortality and minimal complications.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
Background:
- Infants with ventricular septal defects (VSD) often present with failure to thrive and intractable congestive heart failure.
- Surgical intervention for VSD in very young or low-weight infants remains a challenge.
Purpose of the Study:
- To evaluate the safety and efficacy of patch closure for ventricular septal defects (VSD) in infants, regardless of age or weight.
- To assess short-term and long-term outcomes, including mortality, morbidity, and residual defects.
Main Methods:
- Retrospective analysis of 50 infants undergoing VSD patch closure with deep hypothermic circulatory arrest.
- Infants ranged from 13 days to 18 months, with 17 under 3 months of age and all below the third percentile for weight.
- Postoperative assessment included clinical evaluation, neurological monitoring, and cardiac catheterization at one year.
Main Results:
- A 6% mortality rate was observed within the second postoperative month; no late mortality occurred.
- Seizures were reported in 14% of infants, associated with low output or hypoxic episodes.
- Postoperative conduction abnormalities included right bundle-branch block (32%) and combined right bundle-branch block with left anterior hemiblock (17%).
- One-year follow-up catheterization revealed no significant residual VSDs and normal pulmonary artery pressures.
Conclusions:
- Primary patch closure of VSD is a safe and effective procedure in infants, even those with advanced age or low weight.
- The surgical approach yields excellent long-term results with a low incidence of residual defects and normal hemodynamics.
- While complications like seizures and conduction abnormalities can occur, they do not negate the overall positive outcomes of VSD repair.
Abstract:
Fifty infants ranging in age from 13 days to 18 months (mean age 6 months) and weighing from 1.7 to 8.2 kg (mean weight 4.5 kg) underwent patch closure of a ventricular septal defect (VSD) with use of deep hypothermic circulatory arrest. Seventeen infants were under 3 months of age. The principal indication for operation was intractable chronic congestive heart failure; All infants were below the third percentile for weight preoperatively; Three patients (6%) died postoperatively within the second month of life. There was no late mortality. Seven infants (14%) had seizures; these were associated with a low output state in 2 infants, with hypoxic episodes in 4 infants, and occurred postoperatively in 1 infant. Postoperatively, 8 (17%) of the surviving infants developed right bundle-branch block and left anterior hemiblock, and 16 (32%) developed right bundle-branch block alone. One year postoperatively, catheterization studies in 24 children revealed normal pulmonary artery pressure and pulmonary vascular resistance in all; there were no significant residual ventricular septal defects. Because of these results we continue to be enthusiastic about primary closure of VSD irrespective of age or weightk0