effect of residual ventricular septal defects on early clinical outcome: Initial experience

ABSTRACT

Residual ventricular septal defect [VSD] after repair of isolated VSD or Fallot's tetrology is one of the main causes of morbidity and re-operations. In this paper we have presented the results of our initial experience regarding the management of this problem. The data consists of 71 patients [22 isolated VSD and 49 Fallot's tetrology] operated during January, 1991 to July, 1993. The incidence of residual VSD as shown by colour doppler study at the time of discharge from hospital and at three month's follow-up was 43 out of 60 patients [73%] and 12 out of 60 [20%] respectively. Six out of these 12 patients were NYHA class III-IV who underwent cardiac catheterization which revealed patch dehiscence in two patients and residual right ventricular outflow tract obstruction in four patients. The two patients, with patch dehiscence, were reoperated successfully with very good outcome. Simple colour doppler mapping tends to over-diagnose residual VSDs since it can pick up small hemodynamically insignificant leaks around stitches and needle holes which seal off in due course. The findings of colour doppler should, therefore, be correlated with actual clinical outcome in order to proceed with further investigations and re-operation