VENTRICULAR SEPTAL DEFECT IN INFANTS AND CHILDREN WITH INCREASED PULMONARY VASCULAR RESISTANCE AND PULMONARY HYPERTENSION - SURGICAL MANAGEMENT: LEAVING AN ATRIAL LEVEL COMMUNICATION
Abstract
Objective : To evaluate the surgical and medical efficacy of the patients operated for VentricularSeptal Defect (VSD) with Pulmonary Hypertension and Pulmonary Vascular Resistance (PVR).Infants and children with elevated PVR and Pulmonary Hypertension are associated withsignificant mortality and morbidity after surgical closure. Circulatory assist devices andsophisticated medicines may not be available to help in the management of infants and childrenwith elevated Pulmonary artery pressure and resistance. We left Patent Foramen Ovale (PFO) ormade atrial communication to decrease the morbidity and mortality associated with the closure oflarge VSD in this risky group. Methods : Sixteen infants and children were operated with medianage of 12 months, operated by the same surgeon (IU), from January’ 2004 to December’ 2005 .They were with large VSD of elevated PVR (3.9+0.3) and underwent VSD closure leaving PFO orartificial ASD (5mm). Surgical approach was through right atrium. Post operatively, all thepatients were electively ventilated for 36 hours. They were given intravenous dilators (GlyceralTrinitrate + Phentolamine) and oral Sildenafil up to 1mg /Kg, six hourly. Five cases went intoacute pulmonary hypertensive crisis postoperatively, and were rescued by ProstacyclineNebulization. Results: Sixteen patients had VSD as the primary lesion that underwent operation.The overall early mortality was 6.25% (1/16). There have been no late deaths. Conclusion:Closure of large VSD with elevated PVR can be performed, leaving PFO or artificial ASD, withacceptable mortality and morbidity.References
Nygren A, Sunnegardh J, Berggren H. Preoperative
evaluation and surgery in iso lated ventricular septal defects:
a 21 year perspective. Heart 2000;83:198-204.
Bhatt M, Roth SJ, Kumar RK, Gauvreau K, Nair SG,
Chengode S et al. Management of infants with large,
unrepaired ventricular septal defects and respiratory infection
requiring mechanical ventilation. J Thorac Cardiovasc Surg
;127:1466-73.
Goldman AP, Delius RE, Deanfield JE, de Leval MR,
Sigston PE, Macrae DJ. Nitric oxide might reduce the need
for extracorporeal support in children with critical
postoperative pulmonary hypertension. Ann Thorac Surg
;62:750-5.
J Ayub Med Coll Abbottabad; 18(4)
Goldman AP, Delius RE, Deanfield JE, Marcae DJ. Nitric
oxide is superior to prostacyclin for pulmonary hypertension
after cardiac operations. Ann Thorac Surg 1995; 60:300-5;
Bando K, Turrentine MW, Sun K, Sharp TG, Ensing GJ,
Miller AP et al. Surgical management of complete
atrioventricular septal defects. A twenty year experience. J
Thorac Cardiovsac Surg 1995;110:1543-54.
Schulze-Neick I, Li Penny DJ, Redington AN. Pulmonary
vascular resistance after cardiopulmonalry bypass in infants:
effect on postoperative recovery. J Thorac Cardiovasc Surg
; 121:1033-9.
Carotti A, Marino B, Bevilacqua M, Marcelletti C, Rossi E,
Santoro G et al. Primary repair of Isolated Ventricular Septal
Defect in Infancy Guided by Echocardiography. Am J
Cardiol 1997;79:1498-1501.
Knott-Craig CJ, Elkins RC, Lane MM, Holz J, McCue C,
Ward KE.Knott-Craig CJ,Elkins RC, Lane MM, et al. A 26-
Year Experience with surgical management of Tetralogy of
Fallot: Risk Analysis for Mortality or Late Reintervention.
Ann Thorac Surg 1998;66:506-11
Novick WM, Sandoval N, Lazorhysynets VV, Castillo V,
Baskevitch A, Mo X. Flap Valve Double Patch Closure of
Ventricular Septal Defects in Children With Increased
Pulmonary Vascular Resistance. Ann Thorac Surg 2005;
:21-8.
Kannan BR, Sivasankaran S, Tharakan JA, Titus T, Ajith
Kumar VK, Francis B et al. Long-term outcome of patients
operated for large ventricular septal defects with increased
pulmonary vascular resistance. Indian Heart J.2003;55:161.
Wessel DL. Current and future strategies in the treatment of
childhood pulmonary hypertension. Progr Pediatr Cardiol
;12:289-318.
Trachte AL, Lobato EB, Urdaneta F, Hess PJ, Klodell CT,
Martin TD et al. Oral Sildenafil Reduces Pulmonary
Hypertension After Cardiac Surgery. Ann Thorac Surg 2005;
:194-7.
Moritz A, Ozaslan F, Dogan S, Abdel-Rahman U, Aybek T,
Wimmer-Greinecker G. Closure of atrial and ventricular
septal defects should be performed by the surgeon. J Interv
Cardiol.2005;1 8(6):523-7.
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