Hemodynamic Changes after Surgical Closure of Ventricular Septal Defect.

Abstract

This is a prospective study that was carried out during the period between January 1990 to January 2000, to assess the hemodynamic changes and outcome after surgical closure of ventricular septal defect (VSD). Out of 150 patients who underwent surgical closure of VSD, 52 patients had follow up cardiac catheterisation. The main indications for recatheterisation were: persistent respiratory symptoms, clinical or echocardiographic signs of residual leak across the VSD, and improper weight gain. The time interval between recath and surgery was ranging from 3 to 6 months. Complete closure was achieved in 35 patients out of 52 (76%) who had been recatheterized, persistent severe pulmonary hypertension was noticed in one patient who underwent atrial septostomy, 4(8%) patients had significant leak across the defect and high pulmonary hypertension needed a second operation, 12(23%) patients had small residual leak. The mean pulmonary arterial pressure has dropped from 60mmHg to 27 mmHg. Two patients had complete heart block needed an insertion of permanent pacemaker. The hospital mortality of the entire group was 2% and there was no late mortality. In conclusion, hemodynamic changes following the surgical closure of the ventricular septal defect had shown further reduction in the pulmonary pressure and pulmonary vascular resistance as early as 3 months in most patients, rarely some patients needed another attempt of closure of the residual VSD leak. Surgical atrial septostomy might be needed in patients with persistent severe pulmonary hypertension to decompress the right side of the heart.