ABSTRACT
Late presentation of patients with large ventricular septal defect (VSD) and elevated pulmonary vascular resistance (PVR) is not uncommon in developing countries. Surgical VSD closure in these patients carries risks of persistent pulmonary hypertension, right ventricular failure, and mortality. Several techniques for creation of valved patches or fenestrated patches have been developed to address these issues. We have successfully used a simple and easily reproducible technique in which a cruciate fenestration is created in the patch used for VSD closure.
Subject(s)
Cardiac Surgical Procedures/methods , Heart Septal Defects, Ventricular/surgery , Hypertension, Pulmonary/surgery , Vascular Resistance/physiology , Child , Female , Follow-Up Studies , Heart Septal Defects, Ventricular/complications , Humans , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Male , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Decisions to operate on patients with shunt lesions presenting late with severe pulmonary arterial hypertension (PAH) and borderline operability are often not based on precise cut off values of haemodynamic data owing to paucity of studies. OBJECTIVE: To assess the reliability of the preoperative haemodynamic data and reactivity test in predicting the postoperative reversibility of PAH in patients with isolated large ventricular septal defects (VSDs) and borderline operability. PATIENTS AND METHOD: Between 2004 and 2010, 30 patients underwent VSD closure surgically; no early deaths occurred. Twenty-six patients were followed up regularly (mean 39.6±16â months) and one late postoperative death occurred. Fourteen patients who had been followed up for at least 1â year postoperatively underwent cardiac catheterisation. RESULTS: There were 3 responders (asymptomatic patients with pulmonary vascular resistance (PVR) index <3â WU.m(2)) and 12 non-responders. The following were lower among responders: mean age at surgery (3.2±0.42 vs 11.55±3.29â years, p=0.227), mean baseline PVR index (3.69±0.8 vs 10.57±9.1, p=0.204), average resistance ratio (RR=0.25±0.01 vs 0.59±0.25, p=0.049) and ratio of pulmonary and systemic mean pressures (PAm:SAm ratio) (0.70±0.009 vs 0.87±0.118, p=0.003). CONCLUSIONS: Preoperative 'base line' PAm:SAm and RR appear to be better predictors of postoperative outcome than other baseline parameters. Preoperative reactivity test had no significant role in predicting postoperative reversibility of PAH at mid-term.
ABSTRACT
Kawasaki disease was first described 30 years ago. The authors report 5 children with Kawasaki disease who presented within 18-month-period and describe their clinical presentation and management.
