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

Abstract

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.

Ventricular Septal Defects

“…28 More recent studies have shown residual defects in 31% of patients and an incidence of complete heart block of 3.1%. 29 Another natural history study showed occurrence rates for pacemaker placement of 9.8 per 10 000 patient-years and occurrence rates for endocarditis of 16.3 per 10 000 patientyears in operated patients. 30 …”

Screening for differential methylation status in fetal myocardial tissue samples with ventricular septal defects by promoter methylation microarrays

“…Currently, pre-natal diagnosis of VSD is relatively difficult and surgical treatment of VSds carries both mortality and morbidity risks, even though it is the most common open heart procedure performed in pediatric cardiac surgery (11,12). The heart is the first organ to form during embryogenesis, and its development is controlled by a series of important genes (13).…”

Safety and efficacy of amplatzer duct occluder for percutaneous closure of ventricular septal defects with tunnel shape aneurysm: Medium term follow up

“…In 1954, Lillehei and associates performed the first surgical closure of a congenital ventricular septal defect [3]. Since then, surgical closure has been regarded as the gold standard treatment, albeit it remains associated with morbidity and mortality, postoperative discomfort and the need for sternotomy and a residual scar [4,5]. Because of the complications associated with surgical closure, percutaneous closure has been advocated and in 1988 Lock et al [6] reported the first human experience of transcatheter closure of muscular defects.…”