Abstract
Ventricular septal defect (VSD) is the most commonly diagnosed congenital heart defect presenting with failure to thrive. Surgical closure of the defect is the treatment of choice for these patients and should be done preferably in infancy. We present our experience of 84 patients of isolated VSD below one year of age treated in our hospital over period of four years. The median age of patient was 8 months (range 2 months to 11.5 months) and a median weight of 5 kg (range 2.5 kg to 9 kg). The following VSD types were found: 74 perimembranous (88%), 2 supracristal (2.3%), 3 inlet (3.5%) and 5 muscular (5.9%). Most common indication was recurrent pneumonias and failure to thrive. Pulmonary artery hypertension was present in 55 patients (65%) out of 84.
None of our patient was re-operated for residual VSD. Median extubation time was 12 hours (range 6 hours to 30 hours), median ICU stay was 3 days (range 2 to 15 days) and median hospital length of stay was 5 days (range 4 to 26 days). There were 2 early mortalities (2.3%) and 1 late death (1.15%) in our series. 1 patient developed complete heart block requiring permanent pacemaker implant. 50 patients were discharged on medication for pulmonary hypertension. Pulmonary hypertension regressed over median time of 2 months. On median follow up of 2 years, 80 patients (95%) were asymptomatic. No patient had new onset aortic or tricuspid regurgitation greater than trivial postoperatively.
We concluded early surgical closure of VSD in infancy is treatment of choice for patients with VSD with low mortality and extremely low incidence of adverse events.
References
- Hoffman JI, Kaplan S, Liberthson RR. Prevalence of congenital heart disease. Am Heart J. 2004;147:425-39.
- Mavroudis C, Backer CL, Jacobs JP. Ventricular septal defect. In: Mavroudis C, Backer CL, eds. Pediatric cardiac surgery, 3rd ed. Philadelphia: Mosby, 2003:298 –320.
- Anderson BR, Stevens KN, Nicolson SC et al (2013) Contemporary outcomes of surgical ventricular septal defect closure. J Thorac Cardiovasc Surg 145(3):641–647
- Kogon B, Butler H, Kirshbom P, Kanter K, McConnell M (2008) Closure of symptomatic ventricular septal defects: how early is too early? Pediatr Cardiol 29(1):36–39
- Roos-Hesselink JW, Jeijboom FJ, Spitaels SE, et al. Outcome of patients after surgical closure of ventricular septal defect at young age: longitudinal follow-up of 22–34 years. Eur Heart J 2004;25:1057– 62.
- Meijboom F, Szatmari A, Utens E, et al. Long-term follow-up after surgical closure of ventricular septal defect in infancy and childhood. J Am Coll Cardiol 1994;24:1358–64.
- Scully BB, Morales DL, Zafar F, McKenzie ED, Fraser CD Jr, et al. (2010)Current expectations for surgical repair of isolated ventricular septal defects. Ann Thorac Surg 89: 544-549.
- Vaidyanathan B, Roth SJ, Rao SG, Gauvreau K, Shivaprakasha K, et al. (2002) Outcome of ventricular septal defect repair in a developing country. J Pediatr 140: 736-741
- Nygren A, Sunnegårdh J, Berggren H (2000) Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 year perspective. Heart 83: 198-204.
- Scully BB, Morales DL, Zafar F, McKenzie ED, Fraser CD Jr, et al. (2010) Current expectations for surgical repair of isolated ventricular septal defects. Ann Thorac Surg 89: 544-549.
- Koukchoukos NT, Blackston EH, Doty DB et al. Ventricular septal defect, in Kirklin/Barrat-Boyes cardiac surgery, 3rd edn. Churchill Livingstone, Philadelphia. 2003.
- Aydemir NA, Harmandar B, Karaci AR et al. Results for surgical closure of isolated ventricular septal defects in patients under one year of age. J Card Surg. 2013;28(2):174-9
Corresponding Author
Dr Narender Singh Jhajhria
Prof Dept of CTVS, Dr RML Hospital, New Delhi, India
Telephone: 01123404562, Fax: 0112374788, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.33
