RESUMO
The article presents the results of urgent surgical correction of ventricular septal defects (VSDs) and a range of associated congenital heart diseases (CHDs) in 123 children of the first 6 months of life, hospitalized between 1988 and 2002 in a severe or critical condition. In 102 patients the progression of clinical symptoms was caused by a big single VSD and in 21 patients--by multiple VSDs. 70 patients had significant associated CHDs. Significant extracardiac anomalies were revealed in 75 patients. The condition of 55.3% of children had deteriorated due to pneumonia. Correction of defects with cardiopulmonary bypass was performed after urgent examination and intensive therapy. Hemodynamically significant VSD were closed in 117 (95.2%) patients. Two patients were reoperatied due to the presence of residual VSD. Partial or full simultaneous correction of associated CHDs was performed in 68 patients. 93.5% of patients with isolated VSDs survived the operation. The survival rate of patients with associated CHDs and extracardiac anomalies was 81.5%. Postoperative mortality risk factors were found to be critical condition at hospitalization and preoperative activity of infectious process (P < 0.01 and < 0.05, respectively). Accumulation of experience and introduction of a special approach allowed an 8-time decrease of the hospital mortality, which has not exceeded 3.4% within last 3 years. Good and excellent follow-up results were obtained in 98% of the survived patients within 10 to 67 months after operation. Precise diagnostics of associated CHDs and extracardiac anomalies, intensive preoperative treatment and weighed estimation of indications and risk factors allow significant improvement in the results of primary correction of VSD and accompanying cardiovascular anomalies in children of the first months of life in a heavy and critical condition upon admission.
