Surgical Management of Ventricular Septal Defect in Infancy

영아기의 심실중격결손에 대한 이라완전교정술과 단계교정술의 비교

  • Published : 1994.01.01

Abstract

Eighteen infants with a large ventricular septal defect[VSD] underwent primary surgical repair from January 1986 to December 1992. Operation was done because of failure to thrive, medically intractable heart failure, recurrent pneumonia, increased pulmonary vascular resistance[PVR]. Four patients[22.2%] died in the early postoperative period. Relief of heart failure and normalization of growth and weight gain was evident in all survivor. There was no late postoperative death. The results of primary surgical repair of VSD in infancy are compared with those of palliative pulmonary artery banding[PAB] and of VSD closure after PAB. Twenty-seven patients with isolated VSD or with VSD associated with atrial septal defect, patent ductus arteriosus, or coarctation of the aorta underwent initial palliative PAB. There were 3 early postoperative deaths[11.1%]. Severe elevation of PVR persisted in two patients. Closure of VSD and pulmonary artery debanding was done in twenty patients, with 2 early postoperative deaths[10.0%]. Placement of the PAB too close to the pulmonary annulus necessitated trasannular patching in one patient, but any problem caused by migration of the band was not developed. It is concluded that primary surgical repair of VSD in infancy is reasonable and that PAB is indicated only for those patients less than 6 months old with a complicated defect or in an emergency situation.

Keywords

References

  1. J Thorac Cardiovasc Surg v.88 Pulmonary artery banding Albus,R.A.;Trusler,G.A.;Izukawa,T.;Williams,W.G.
  2. Br Heart J v.43 Classification of ventricular septal defect Soto,B.;Becker,A.E.;Moulaert,A.J.;Lie,T.;Anderson,A.H.
  3. Thoracic and Cardiovascular Surgery(5th ed.) Ventricular septal defect Arciniegas,E.;Glenn,W.W.L.
  4. Circulation v.31;32 no.Suppl 3 Ventricular septal defect Ritter,D.G.;Feldt,R.H.;Weidman,W.H.
  5. Am Heart J. v.84 Ventricular septal defect. Clinical and hemodynamic changes in the first five years of life Collins,G.;Calder,L.;Rose,V.;Kidd,L.;Keith,J.
  6. Pediatrics v.39 Early surgical correction of large ventricular septal defect Sigmann,J.M.;Stern,A.M.;Sloan,H.E.
  7. J Thorac Cardiovasc Surg. v.80 Pulmonary artery banding: An analysis of risks, results, and indications Stewert,S.;Harris,P.;Manning,J.
  8. J Thorac Cardiovasc Surg. v.91 Results of Surgical treatment of coarctation of the aorta in the critically ill neonate:including the influence of pulmonary artery banding Goldman,S.;Hernandez,J.;Pappas,G.
  9. J Thorac Cardiovasc Surg. v.80 Surgical closure of ventricular septal defect during the first twelve months of life Eduardo,A.;Zia,Q.F.;Mehdi,H.;Burton,L.P.;Edward,M.G.
  10. J Thorac Cardiovasc Surg. v.71 Repair of ventricular septal defect after pulmonary artery banding Walter,S.E.;George,J.R.;Grady,L.H.;Denton,A.C.
  11. Ann Thorac Surg. v.44 Pulmonary artery banding: Results and current indications in pediatric cardiac surgery Leblane,J.G.;Ashmore,P.G.;Pineda,E.;Sandor,G.G.;Patterson,M.W.;Tipple,M.
  12. Pediatrics v.27 Repair of ventricular septal defect in infancy Kirklin,J.W.;Dushand,J.W.
  13. Ann Thorac Surg. v.17 Intracardiac surgery with extracorporeal circulation in infants Boncheck,L.I.;Anderson,R.P.;Wood,J.A.
  14. J Thorac Cardiovasc Surg. v.75 Surgical management of ventricular septal defect in infants McNicholas,K.W.;Bowman,F.O.;Hayes,C.J.;Edie,R.N.;Malm,J.R.
  15. Ann Thorac Surg. v.22 Surgical treatment of large ventricular septal defect with pulmonary hypertension in the first 24months of life Suzuki,Y.;Ishizawa,E.;Tanaka,S.(et al.)