Long-term results of primary closure for ventricular septal defects in the first year of life

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.

Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 year perspective

“…2 18 23 24 38 39 In spite of a high incidence of patch leakages revealed by colour Doppler in the immediate postoperative period after VSD surgery, few studies have concerned the fate of such leakages over time. In the present study, the number of children with a patch leakage, as studied by colour Doppler, was found to decrease over time (fig 3).…”

Transcatheter device versus surgical closure of ventricular septal defects: A clinical decision analysis

“…A Medline search of the published literature between 1975 and 2005 was performed to identify peer‐reviewed reports related to transcatheter device and surgical closure of VSDs; reports were reviewed and selected for inclusion if their primary focus was the management of uncomplicated isolated VSDs. Based on these criteria, a total of 18 published scientific reports were selected: nine reports [1, 3–5, 9, 11–14] focused on transcatheter device closure with results reported for 342 patients, and nine reports [15–23] focused on surgical closure with results reported for 605 patients.…”

Caliber of Quality-of-Life Assessments in Congenital Heart Disease

“…The evaluation of quality of life has become increasingly important in children, adolescents, and adults with congenital heart disease. This may be because of the longer *References 8, 15,16,18,19,23,28,29,31,33,35,37,39,41,42,47,48,55,60,61,68,70,72,77. †References 7,14,17,20,22,26,32,34,38,[43][44][45][46][50][51][52][53][54][57][58][59][62][63][64][65][66][67]69,71,…”

“…#References 9,17,19,21,23,26,27,35,40,42,52,55,56,64,70,72. ** References 7,13,33,37,46,49,62,66,78,79. (REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 158, NOV 2004 life expectancy of these patients, as well as the physical, psychological, and social impediments experienced by them. Quality of life is, however, an equivocal concept (P.M., W.B., and S.D.G., unpublished data, 2004).…”