ABSTRACT
Background: closure of ventricular septal defects [VSDs] in infancy due to pulmonary hypertension has greatly replaced pulrnonary artery banding. This approach has been extended to infants with multiple VSDs, closing large VSD and in many cases leaving small muscular VSDs behind. The hemodynamic relevance and rate of closure of these VSDs are unknown. The purpose of this study was to assess the outcome of infants with multiple VSDs after surgical closure of a large VSD leaving another small muscular VSD [s] behind
Patients and Methods: this prospective study was done between January 2004 and December 2005, in the department of Cardio-thoracic Surgery, Abu El-Rish Children Hospital Aff./ Kasr El-Ainy Hospital, Faculty of Medicine, Cairo University. The study sample consisted of 20 infants who were operated for closure of multiple VSDs, closing only the large haemodynamically significant VSD and leaving other small muscular VSD[s]. Tran thoracic echocardiography [TTE], preoperative and postoperative, in the intensive care unit, at hospital discharge, and during follow-up, were performed for all patients. Intra-operative transesophageal echocardiography [TEE] was performed for last 9 patients. Mean follow-up time was 1.5 years [range 0.25- 3.0 years]. Residual defects were graded as absent, < 2 m or between 2 and 4 mm
Results:- due to a pulmonary hypertensive crisis, one patient [5%], died in the 1.C.U comprising our single early postoperative hospital mortality. Morbidity occurred in only one patient [5%] in the form of conduction disturbances which needs implanting a permanent DDD-pacemaker. Follow-up was complete in 17 patients [85%] as only 3 patients [15%] were lots of follow-up. During follow-up no reoperations were necessary for closing a residual VSD. After discharge, all residual defects less than 2 mm closed. Of residual defects greater than 2 mm. only one closed after a man follow-up of 2.4 years. All patients with residual shunts, were hemodynamically stable, requiring no or minimal medication and in none of them endocarditis was noted
Conclusion: our results showed that in infants, postsurgical residual muscular VSDs less than 2mm closed spontaneously in the majority within 1.5 years. Defects greater than 2mm are less likely to close spontaneously. At early follow-up. Residual shunts remained hemodynamically and clinically irrelevant