Document Detail


Outcomes of intraoperative device closure of muscular ventricular septal defects.
MedLine Citation:
PMID:  11515876     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The surgical management of muscular ventricular septal defects (mVSD) in the small infant is a challenge particularly when multiple and associated with complex cardiac lesions. Devices for percutaneous implantation have the advantage of ease of placement and for the double umbrella designs a wide area of coverage. We reviewed our experience and clinical outcomes of intraoperative mVSD device closure for such defects in small infants. METHODS: Since October 1989, intraoperative VSD device closure was a component of the surgical strategy in 14 consecutive patient implants (median age, 5.5 months; range, 3 to 11 kg), whose defects were thought difficult to approach using conventional techniques. Nine patients had associated complex cardiac lesions, 10 multiple mVSDs, and 4 patients had a previous pulmonary artery banding. RESULTS: There were 2 early deaths, 1 in a severely ill child who preoperatively had pulmonary hypertension and left ventricular failure and another in a patient with a hypoplastic left heart. Mean pulmonary to systemic flow ratio before device insertion was 3.5:1. Complete closure was achieved in 5 patients and clinically insignificant residual shunts persisted in 7. In 2 infants with significant residual lesions concomitant pulmonary artery banding was required. Postoperative mean pulmonary to systemic flow ratio was 1.7:1. In follow-up of the 12 surviving infants (mean, 41 months), 8 had complete closure and 3 persistent residual shunts. One patient with no residual shunting required heart transplantation for progressive ventricular failure 9 years after operation. All devices were well positioned on postoperative echocardiograms. There was 1 late death due to aspiration in a patient with a tiny residual shunt. CONCLUSIONS: Infants requiring operative intervention with mVSDs are difficult to manage and have an increased mortality and morbidity. Intraoperative VSD device placement for closure of mVSDs is feasible, can avoid ventriculotomy, division of intracardiac muscle bands, and is ideally suited for the neonate or infant.
Authors:
M Okubo; L N Benson; D Nykanen; A Azakie; G Van Arsdell; J Coles; W G Williams
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  72     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-08-22     Completed Date:  2001-09-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  416-23     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics and Surgery, The Hospital For Sick Children, The University of Toronto School of Medicine, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Echocardiography
Echocardiography, Transesophageal
Female
Follow-Up Studies
Heart Defects, Congenital / mortality,  surgery*,  ultrasonography
Heart Septal Defects, Ventricular / mortality,  surgery*,  ultrasonography
Humans
Infant
Infant, Newborn
Male
Postoperative Complications / mortality,  ultrasonography*
Prosthesis Implantation*
Reoperation
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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