Conduction defects, ventricular arrhythmias, and late death after surgical closure of ventricular septal defect.

Blake, R. S.; Chung, Edward; Wesley, H; Hallidie-Smith, K A

doi:10.1136/hrt.47.4.305

Cited by 49 publications

(7 citation statements)

References 26 publications

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“…In this study, no late mortality occurred, in contrast to findings in other studies in which late mortality ranged from 9.0% to 20.3% in surgical procedures performed before 198018 19 38 and from 0% to 4.3% in studies after 1980 13 4 Serious long term complications were found in the present study and included developmental retardation in at least one patient caused by severe cerebral complications at the time of surgery.…”

Section: Discussioncontrasting

confidence: 96%

“…2 18 23 24 38 39 In spite of a high incidence of patch leakages revealed by colour Doppler in the immediate postoperative period after VSD surgery, few studies have concerned the fate of such leakages over time. In the present study, the number of children with a patch leakage, as studied by colour Doppler, was found to decrease over time (fig 3).…”

Section: Discussionmentioning

confidence: 99%

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Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 year perspective

Nygren

Sunnegårdh

Berggren

2000

Heart

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Objective-To study short and long term results after surgical closure of isolated ventricular septal defects (VSDs) from 1976 to 1996, especially in relation to changes in preoperative evaluation during this period. Design-Retrospective study. Setting-Tertiary referral centre for paediatric cardiac care. Patients-All children under 18 years of age who had corrective surgery for VSD between 1976 and 1996. Main outcome measures-Preoperative evaluation, indications for surgery, diagnostic errors, and early and late results. Results-A significant decrease in the use of invasive preoperative studies in favour of non-invasive methods was found; from 1976 to 1990, a total of 109/110 patients had preoperative invasive study as compared to 43/167 from 1991 to 1996 (p < 0.001). Pulmonary hypertension in small children, without detailed information on Qp:Qs ratio, as well as small or modest shunts without pulmonary hypertension, were more frequent indications for surgery in recent years. Early mortality after surgery occurred in 10 patients, with a significantly lower mortality rate found between 1991 and 1996 than between 1976 and 1990 (0.6% v 8.2%, p < 0.001).Children with large VSDs experienced perioperative complications significantly less often between 1991 and 1996 than between 1976 and 1990 (16/105 v 28/96, p < 0.05). Diagnostic errors showed a tendency to decrease between the two time periods. No late deaths occurred. Conclusions-Significant reductions in early mortality, perioperative complications, and diagnostic mistakes were seen during the study period, even though less invasive diagnostic procedures were being performed.

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 year perspective

Nygren

Sunnegårdh

Berggren

2000

Heart

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“…A variety of factors have been associated with the development of VT in patients with CHD, including the type of CHD, age of patients at time of surgery, the era during which the operation was performed, length of cardiopulmonary bypass and aortic cross clamp time, and hemodynamic results. [2][3][4][6][7][8][9][10][11][12][13][14] The purpose of this Review is to provide an overview of the etiology, diagnosis, and treatment of VT in pediatric and adult patients with CHD. Specifically, the potential causes of VT, the importance of differentiating between VT and supraventricular tachycardia, and the use of diagnostic testing such as Holter monitoring and exercise stress testing will be examined, as will the use of cardiac catheterization and electrophysiology for the risk stratification of patients.…”

Section: Introductionmentioning

confidence: 99%

Postoperative ventricular tachycardia in patients with congenital heart disease: diagnosis and management

Snyder

2008

Nat Rev Cardiol

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Ventricular tachycardia (VT) after palliative repair of congenital heart disease is relatively rare. Despite this rarity, VT is a known cause of early, intermediate and late morbidity and mortality in these patients. A number of factors have been linked to the development of VT in this unique patient population. The purpose of this article is to provide a concise overview regarding the etiology, diagnosis and treatment of VT in patients with congenital heart disease. In-depth information will be provided to aid diagnosis and the treatment of early postoperative VT. The use of additional diagnostic methods such as echocardiography, cardiac catheterization and electrophysiology studies to risk assess patients with postoperative VT will also be discussed. In addition, I examine the long-term management strategies for VT in these patients, from medical management and cardiovascular surgery to implantation of cardioverter-defibrillators.

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“…Apart from reducing the haemodynamic effects of the operation, the presence of a residual VSD increases the risk of BE (11,44).…”

Section: Ventricular Septa1 Defect 33mentioning

confidence: 99%

Long Term Results after Operative Treatment of Isolated Ventricular Septal Defect in Adolescents and Adults

Otterstad

Erikssen

Frøysaker

et al. 1986

Journal of Internal Medicine

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A series of 125 consecutive patients with isolated ventricular septal defect (VSD) aged 10 or over, were followed until death or beyond the age of 30 (31–73) years. A prospective restudy was performed after a mean follow‐up of 15 (3–21) years. Forty‐one patients (group 1) were treated with surgical repair of VSD at a mean age of 23 (10–51) years, and early mortality was 10%, i.e. 3 with severe aortic insufficiency and one wity systemic pulmonary artery pressure. Surgery was initially not regarded indicated in 70 patients with small defects (group 2). A further 14 patients were judged inoperable (group 3). Long‐term mortality was 5% in group 1, 9% in group 2 and 71% in group 3. When restudied, group 2 patients had significantly higher (p<0.01) and group 1, lower (p<0.01) pulmonary artery pressures than initially. A moderate deterioration in NYHA‐rating was noted in group 2 (p<0.05) vs. a slight improvement in group 1 (p<0.05). The non‐operated patients had a higher incidence of valvular lesions (19% vs. 13%) and bacterial endocarditis (4.3% vs. 2.7%) than the operated but not to a statistically significant level. Spontaneous closure was 6% in group 2 whereas mostly small residual defects were found in 34% of the operated. Patients with uncomplicated VSDs (absence of valvular lesions or coronary heart disease) had subnormal exercise tolerance as judged from a standardized ergometer bicycle test. These patients also had impaired left ventricular function based upon haemodynamic studies during moderate supine exercise. No major differences were noted between groups 1 and 2, but operated patients with residual VSDs tended to have the poorest cardiac performance. Non‐cardiac disease represented only a minor problem and no significant differences in psychosocial function were observed between groups 1 and 2. Only 50% in group 1 and 60% in group 2 attended a regular medical clinic. Antibiotic prophylaxis had only been practiced by 50% in both groups. Although small, but differences between groups 1 and 2 favour surgery. This must be regarded as a positive result of surgical treatment since those operated on had basically larger and thus more severe defects than the others. In view of the very low operative risk associated with modern surgical technique one should direct patients with significant shunts to operative treatment.

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Conduction defects, ventricular arrhythmias, and late death after surgical closure of ventricular septal defect.

Cited by 49 publications

References 26 publications

Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 year perspective

Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 year perspective

Postoperative ventricular tachycardia in patients with congenital heart disease: diagnosis and management

Long Term Results after Operative Treatment of Isolated Ventricular Septal Defect in Adolescents and Adults

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