Surgical outcome of ventricular septal defect closure in infants and young children : a 7-year jordanian experience

Abstract EN

Objective : To evaluate the surgical outcome of primary closure of ventricular septal defects in children.

Methods: This retrospective study was carried out between January 1990 and January 1997.

One hundred and nine patients with failure to thrive, congestive heart failure or pulmonary hypertension, underwent primary surgical closure of a ventricular septal defect (V.S.D) at Queen Alia Heart Institute.

There were 59 males and 50 females.

Age ranged from 0.5-13 years and body weight from 4.5-3Okg.

The mean pulmonary to systemic flow ratio was 2.3:1.

The mean systolic pulmonary artery pressure (PAP) was 58.4mmHg, and the mean pulmonary vascular resistance (PVR) was 8.37 units.

The basic anomaly was isolated V.S.D in 84 patients.

The others had associated patent ductus arteriosus or atrial septal defect Results : Complete closure of the defect was achieved in 100 patients (91.7 %), including two patients who died postoperatively.

The residual shunt was large in three, and small in six patients.

The hospital mortality rate was 1.8 % with no late deaths.

Death occurred highest among younger infants with a pre-existing respiratory problem, a large V.S.D and high pulmonary vascular resistance.

Follow-up color echo-doppler was done in 95 patients (88.8 %), while additional follow-up cardiac catheterization was done in 48 patients (44.8 %).

Forty-five patients had normal PAP while three patients had large residual shunt and high PAP and needed reoperation.

Small insignificant residual leaks were found in six patients.

Conclusion : Primary surgical closure of V.S.D during the first two years of life appears to be safe and effective.

Reduction of heart size and improved exercise tolerance were the most pertinent follow-up findings.

These results are comparable to those already published and encourage efforts at correction before pulmonary vascular resistance rises.