VENTRICULAR SEPTAL DEFECT IN INFANTS AND CHILDREN WITH INCREASED PULMONARY VASCULAR RESISTANCE AND PULMONARY HYPERTENSION - SURGICAL MANAGEMENT: LEAVING AN ATRIAL LEVEL COMMUNICATION
AbstractObjective : 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.
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