Ventricular septal defect: Selection of patients and timing for surgery

Yasui, Hirofumi; M, Yoshitoshi; Miyamoto, Akashi; Kato, Hidenori; Takeda, Yasuo; K, Tokunaga; Tasaki, Hakaru; Tomoike, Hitonobu

doi:10.1016/s0002-8703(77)80170-1

Cited by 7 publications

(2 citation statements)

References 18 publications

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“…Hallidie-Smith et al (1969) regarded a PVR above eight units as their yardstick, but the 42 children in their study were all in an older age group (range 3 to 12 years). More recently Yasui et al (1977) found that simply relating the peak systolic pulmonary artery pressure to the peak systolic systemic pressure (Pp: Ps) was of great practical value in determining the need for surgical treatment in a group of 87 children under the age of 5 years. A ratio of 0-8: 1 was an indication for early operation to prevent the development of pulmonary vascular disease, but below this figure infants could safely be left until their first birthday.…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary hypertension accompanying ventricular septal defect and patent ductus arteriosus. Management in infancy and early childhood.

Reid¹,

Coleman²,

Stevenson³

1979

Thorax

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Forty-one infants and children with the combination of patent ductus arteriosus (PDA) and ventricular septal defect (VSD) were encountered over 20 years. Twenty-four presented in infancy with congestive cardiac failure. Pulmonary hypertension was present in 32, the cause in 19 being increased pulmonary blood flow. Increased pulmonary vascular resistance (PVR) was detected in 13 (indicated by a pulmonary to systemic resistance ratio (Rp : RS) >0 24 1 and PVR>4 units). Thus 22% had a pulmonary artery systolic pressure less than 30 mmHg and 68% had a pulmonary vascular resistance below four units, indicating an unusually mild form of the combined condition in these patients. Surgical management is discussed, and in particular the question of simultaneous closure of the defects during infancy. Cardiac failure, resistant to drug treatment, and increased PVR are indications of operation. The PDA should be closed and only if there is no substantial fall in pulmonary artery pressure is the VSD repaired.Although both ventricular septal defect (VSD) and patent ductus arteriosus (PDA) are common congenital cardiac anomalies occurring singly, the two combined are relatively uncommon (Hallman et al, 1964;Cartmill et al, 1966;Keith et al, 1978).Because of the existence of two separate systemic-pulmonary arterial shunts, pulmonary hypertension would be expected as a common accompaniment and congestive cardiac failure a common presentation in infancy. We present our experience with this combination of defects in 41 infants and children, most of whom were under the age of 2 years. Patients and methodsDuring 1959-78 41 infants and children presented with the combination of PDA and VSD. Patients with additional anomalies (atrial septal defect, coarctation of aorta, and aortic stenosis) were excluded. Thirty-two patients were female and nine male, the age at presentation ranging from 1 month to 11 years (mean 19-7 months) (

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Section: Discussionmentioning

confidence: 99%

“…This procedure has now been superseded in large measure by primary repair of the defect in infancy when indicated (Cartmill et al, 1966;Yasui et al, 1977;Fox et al, 1978).…”

Section: Discussionmentioning

confidence: 99%