Document Detail

The effect of ventricular septal defect enlargement on the outcome of Rastelli or Rastelli-type repair.
MedLine Citation:
PMID:  19619783     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Our purpose was to evaluate the effect of ventricular septal defect enlargement on the early and late morbidity and mortality of patients undergoing Rastelli or Rastelli-type operations. METHODS: A total of 49 patients who underwent Rastelli or Rastelli-type operations between 1991 and 2007 were included in a retrospective follow-up study. Patients were divided into 2 groups: group A had ventricular septal defect enlargement, and group B did not have ventricular septal defect enlargement for comparison. Risk factor analysis for early or late death included patient-related and procedure-related variables, with failure, arrhythmia, and atrioventricular block as outcome parameters. RESULTS: Median age and weight at the time of the operation were 6 years (range, 3 months-22 years) and 17 kg (range, 7-48 kg), respectively. The ventricular septal defect was enlarged in 28 (57%) patients. Ventricular septal defect enlargement showed a significant statistical relation with late ventricular dysfunction, arrhythmia, and residual ventricular septal defect (P = .023, P = .047, and P = .01, respectively, log-rank test). No relation was found between ventricular septal defect enlargement and permanent pacemaker implantation (P = .73, log-rank test). Furthermore, enlargement of the ventricular septal defect did not show any significant effect on the rate of early mortality (P = .69, Cox regression). Kaplan-Meier estimated survival for patients with ventricular septal defect enlargement was 74% at 5 years and 65% at 10 years. Freedom from late death in the group without ventricular septal defect enlargement was 100% at 5 and 10 years and 83% at 15 years. At a median follow-up of 4 years (range, 6 months-16 years), there were 12 late-onset deaths: 11 in group A (n = 28) and 1 in group B (n = 21). Ventricular septal defect enlargement greatly increased the risk of late death (P = .009, Cox regression). CONCLUSIONS: Septal resection in patients undergoing Rastelli or Rastelli-type operations has a substantial effect on late morbidity and is a predictive factor for long-term mortality.
Mohammad Ali Navabi; Reza Shabanian; Abdolrazagh Kiani; Mitra Rahimzadeh
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Publication Detail:
Type:  Journal Article     Date:  2009-05-05
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  138     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-21     Completed Date:  2009-07-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  390-6     Citation Subset:  AIM; IM    
Department of Pediatric Cardiac Surgery, Imam Hospital, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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MeSH Terms
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Cardiac Surgical Procedures / methods
Child, Preschool
Heart Septal Defects, Ventricular / surgery*
Heart Septum / surgery
Heart Ventricles / abnormalities,  surgery
Postoperative Complications
Pulmonary Artery / surgery
Transposition of Great Vessels / surgery*
Young Adult

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