EARLY SURGICAL CORRECTION OF LARGE VENTRICULAR SEPTAL DEFECTS

PEDIATRICS ◽  
1967 ◽  
Vol 39 (1) ◽  
pp. 4-13
Author(s):  
Joan M. Sigmann ◽  
Aaron M. Stern ◽  
Herbert E. Sloan
Keyword(s):  
Pulmonary Hypertension ◽  
Septal Defect ◽  
Pulmonary Infections ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Specific Therapy ◽  
Surgical Closure ◽  
Early Correction ◽  
Septal Defects ◽  
Pulmonary Vascular Obstructive Disease

A significant number of babies born with large ventricular septal defects present early in life as problems in management of congestive heart failure, severe pulmonary hypertension, marked growth retardation, and recurrent pulmonary infections. Review of patients born since December 1954 with ventricular septal defects and followed at our institution allowed for comparison between infants treated surgically and those patients treated either medically or requiring no specific therapy. In 45 infants direct surgical closure of the ventricular defect was undertaken when supportive medical management alone appeared to be inadequate to insure survival or a normal life potential. There was an 80% survival with surgery. All 9 deaths occurred in patients having severe pulmonary hypertension; in some instances additional factors were believed to have contributed to the death of the infant. Nonetheless, surgical mortality appeared to be lower in the infants having severe pulmonary hypertension than among children with a comparable degree of hypertension who were operated on over the age of 2 years. Postmortem examination revealed pathologic changes of advanced pulmonary vascular obstructive disease at as early an age as 8 months. Direct surgical closure of the ventricular septal defect was chosen in preference to the pulmonary artery handing procedure because it not only offers an immediate means of helping the sick infant but also should obviate the necessity of a second major surgical procedure when the patient is older. It is further anticipated that early correction of the septal defect will prove effective in many instances in preventing the serious consequences of pulmonary hypertension.

Surgical repair of atrial septal defect with severe pulmonary hypertension during pregnancy: a case report with literature review

2012 ◽  
Vol 22 (5) ◽  
pp. 493-498 ◽  
Author(s):  
Suganya Manivannan ◽  
Gul Dadlani ◽  
Michael Parsons ◽  
Luminita Crisan ◽  
Victoria Belogolovkin ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Surgical Repair ◽  
Severe Pulmonary Hypertension ◽  
Secundum Atrial Septal Defect ◽  
Viable Option ◽  
Surgical Closure ◽  
Septal Defects ◽  
Pulmonary Arterial

AbstractWe are reporting a case of a 37-year-old pregnant woman with a large secundum atrial septal defect with left-to-right shunt and severe pulmonary hypertension. Her atrial septal defect was undiagnosed before this pregnancy. After carefully considering all the options, we repaired her atrial septal defect with an open heart surgical closure at 20 weeks of gestation. A substantial and consistent reduction in pulmonary arterial pressure after the surgery and subsequent uneventful delivery indicate that surgical repair of atrial septal defects is a viable option that should be considered for such patients.

Abstract 2130: Long-term Outcomes of Adult Atrial Septal Defect With Severe Pulmonary Hypertension After Surgical Closure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jeong-Hoon Kim ◽  
Duk-Hyun Kang ◽  
Jong-Young Lee ◽  
Jong-Min Song ◽  
Tae-Jin Yun ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Elderly Patients ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Survival Rates ◽  
Severe Pulmonary Hypertension ◽  
Term Survival ◽  
Surgical Closure

The benefits of surgical closure has been unclear in adult atrial septal defect (ASD) with severe pulmonary hypertension (PHT), and we tried to evaluate improvement of PHT and long-term survival after surgical closure compared to medical follow-up. Methods: From 1996 to 2006, we included a total of 71 adult ASD patients (age; 43±15 years) with severe PHT documented by echocardiography. The inclusion criteria were defined as ASD diameter > 15 mm, enlarged right ventricle, and the baseline peak velocity of tricuspid regurgitation (TR) ≥ 4.0 m/sec. We excluded 5 patients with Eisenmenger syndrome documented by cardiac catheterization. Surgical closure was performed on 55 patients (OP group) and the remaining 16 patients were followed up medically (MED group). The improvement of PHT was defined as TR velocity ≤ 3.5 m/sec on follow-up echo. Results: Baseline characteristics and clinical results were compared between the two groups in table . There were no significant differences in terms of gender, ASD diameter, cardiac rhythm, and TR velocity, but the MED group was significantly older. During follow-up of 46±33 months, there were 5 deaths in the MED group and no operative or late death in the OP group, and the 5-year actuarial survival rate of the OP group was significantly higher than the MED group (58±15%, p<0.05). On subgroup analysis according to age, the OP group showed significantly better survival rates than the MED group (p<0.05) in elderly patients (age > 50). In the OP group, TR velocity was significantly decreased from 4.5±0.4 to 3.0±0.7 m/sec on follow-up echo, and improvement of PHT was observed in 47 (85%) patients. On multivariate analysis, female gender and lower baseline TR velocity were the significant independent predictors of improved PHT after surgery. Conclusions: In adult ASD with severe PHT, surgical closure can be safely performed and improve PHT effectively. Especially in elderly patients, ASD closure is significantly related with the better survival rates.

Clinical course in children and adolescents with ventricular septal defect

2019 ◽  
Vol 27 (7) ◽  
pp. 529-534
Author(s):  
Noor Mohammad Noori ◽  
Alireza Teimouri
Keyword(s):  
Pulmonary Hypertension ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Clinical Course ◽  
Defect Size ◽  
Eisenmenger Syndrome ◽  
Ventricular Septal Defects ◽  
Laboratory Findings ◽  
Septal Defects

Background Ventricular septal defect, the most common congenital heart defect, is characterized by an opening between the ventricles. This study aimed to evaluate the clinical course and associations between the characteristics of ventricular septal defect. Methods This cross-sectional study was conducted on 1498 children with ventricular septal defects, aged <19 years, who were referred to our center between 2003 and 2018. The diagnosis was suspected from a combination of clinical and laboratory findings, and confirmed by transthoracic echocardiography. Results Of the 1498 children, 54.9% were boys, 78.4% of defects were perimembranous, 30.4% of patients had pulmonary hypertension, 67.5% had regular follow-up, and 76 (5.1%) had complications including 28 (1.9%) with Eisenmenger syndrome; 10 died due to Eisenmenger syndrome during follow-up. The defects closed spontaneously in 38.9% and after surgery in 20.9%. Boys tended to have more perimembranous, inlet, and outlet forms (56.40%, 50.60%, 51.90%, respectively), whereas girls had more muscular types (51.80%). Most patients with pulmonary hypertension had perimembranous defects (83.10%). The majority of patients with pulmonary hypertension had large (63.40%) or moderate (36.60%) defects. Pulmonary hypertension had a significant association with defect size ( p < 0.001). After surgery, residual defects were found mostly in cases of large defects (84.60%). Most patients with spontaneous closure were younger than 4 years. Conclusion Almost four-fifths of children with ventricular septal defects had perimembranous types, and almost one-third had pulmonary hypertension which was associated with defect size. Two-fifths of the defects closed spontaneously. There was a low incidence of complications after surgery.

Pulmonary arterial changes in patients with ventricular septal defects and severe pulmonary hypertension

1986 ◽  
Vol 7 (3) ◽  
pp. 147-154 ◽  
Author(s):  
Ruthellen Fried ◽  
George Falkovsky ◽  
Jane Newburger ◽  
A. I. Gorchakova ◽  
Marlene Rabinovitch ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Pulmonary Arterial

Large Congenital Ventricular Septal Defect: Surgical Closure at Sixty Years

1997 ◽  
Vol 5 (2) ◽  
pp. 124-126
Author(s):  
Mandeep Singh ◽  
Rajendar Krishan Suri ◽  
Neerod Kumar Jha ◽  
Rajnish Juneja ◽  
Harinder Kumar Bali ◽  
...  
Keyword(s):  
Natural History ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
The Elderly ◽  
Ventricular Septal Defects ◽  
Surgical Closure ◽  
Septal Defects

Large congenital ventricular septal defects have an unfavorable natural history and survival to 60 years of age with a large left-to-right shunt is very uncommon; surgical closure of such a defect in the elderly is even rarer. We report the case of a 60-year-old female who presented with a large left-to-right shunt across a congenital subaortic ventricular septal defect and underwent successful surgical closure.

Abstract 15801: Early and Late Risk of Mortality or Development of Severe Pulmonary Hypertension Following Closure of Ventricular Septal Defects in Children With Severe Pulmonary Hypertension and Elevated Pulmonary Vascular Resistance Using Traditional or Uni-directional Flap Valve Patch Closure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
William M Novick ◽  
Oleksandr Golovenko ◽  
Vasyl Lazorhyshynets ◽  
Vitaly Dedovich ◽  
Iryna Perepeka ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Severe Pulmonary Hypertension ◽  
Ventricular Septal Defects ◽  
Risk Of Death ◽  
Septal Defects ◽  
Number Of Patients ◽  
Flap Valve

Introduction: Children with large ventricular septal defects, severe pulmonary hypertension (PHT), and elevated pulmonary vascular resistance (PVR) are frequently denied operation in low and middle-income countries secondary to concerns of high mortality and development of severe pulmonary hypertension following operation, early and late. Hypothesis: We hypothesized that closure with a uni-directional flap valve patch (DP) would provide lower mortality and better survival without severe PHT. Methods: From 5/96 - 12/2016 all patients undergoing VSD closure with severe PHT and elevated PVR by either traditional (TP) or DP closure were followed annually. Baseline and O 2 provocation catheterization were performed before operation. Echocardiograms were performed at discharge and follow-up. The decision on TP or DP closure was based upon age and surgeon preference. Beginning in 2005 all patients regardless of technique received sildenafil 3 mgs/kg/day for 3 months before operation. Results: The number of patients receiving operation was 129, of which 40 received the DP. Males were 66/129, age and weight differed significantly for DP group compared to the TP group (7.5 vs 2.6 years, p<0.001 and 20 vs 11.5 kgs, p<0.001).Catheterization baseline data, PVR 9.0 vs 7.4 for DP and TP respectively (p<0.001), negative vasoactive test 32.5% vs 13.5% for DP and TP respectively (p=0.016). Mortality was 1/40 for DP and 9/89 for TP. Pulmonary to Systemic systolic pressure ratio was lower at discharge vs baseline cath (0.38 vs 0.99, p<0.001). Predictors of late severe pulmonary hypertension were PVR/SVR >0.5, p<0.024; and a negative vasoactive test of <10% decrease, p<0.001. PHT at last follow-up, none or mild 86/115 (74.8%), moderate 16/115 (13.9%) or severe 13/115 (11.3%). Conclusions: DP patients had less risk of death and both groups had few patients with severe PHT at late follow-up..

Familial muscular ventricular septal defects and aneurysms of the muscular interventricular septum

2007 ◽  
Vol 17 (5) ◽  
pp. 523-527 ◽  
Author(s):  
Mugur I. Nicolae ◽  
Kim M. Summers ◽  
Dorothy J. Radford
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Autosomal Dominant ◽  
Interventricular Septum ◽  
Dominant Inheritance ◽  
Ventricular Septal Defects ◽  
Surgical Closure ◽  
Septal Defects ◽  
Precise Diagnosis ◽  
Echocardiographic Evidence

AbstractWe describe 3 siblings with muscular ventricular septal defects, two requiring surgical closure. One of their offspring had a rare congenital aneurysm of the muscular ventricular septum, also requiring surgery. Another had a small muscular ventricular septal defect which closed spontaneously. Their father had echocardiographic evidence suggestive of a closed muscular defect. Paternal cousins have had ventricular septal defect, hypertrophic cardiomyopathy, and tetralogy of Fallot. There was no evidence of 22q11 deletion.Although ventricular septal defects are the most common congenital heart defect, such familial clustering is uncommon. The distribution of cases in this family suggests autosomal dominant inheritance. With echocardiography, and more precise diagnosis of defects which close, a larger genetic component may be revealed in other families.

scholarly journals Closure of a large upper muscular ventricular septal defect in a 2.3 kg baby using a duct occluder

2021 ◽  
Vol 8 (3) ◽  
pp. 165-169
Author(s):  
Mirza Mohd Kamran ◽  
◽  
Shaad Abqari ◽  
Azam Haseen ◽  
Mayank Yadav ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Failure To Thrive ◽  
Ventricular Septal Defects ◽  
Device Closure ◽  
Weight Category ◽  
Surgical Closure ◽  
The Past ◽  
Septal Defects ◽  
Younger Age

Surgical closure of the ventricular septal defect is a time tested and well-accepted procedure to dateespecially in smaller babies with failure to thrive and severe pulmonary hypertension. Surgicalclosure is regarded as the gold standard treatment. However over the past 10 years percutaneoustrans-catheter device closure has emerged as a safer alternative especially in the case of muscularVSD. Transcatheter closure of ventricular septal defects (VSD) has not yet received generalacceptance. It is not well-established in the younger age group with a weight category of less than5kg. Occasionally, a hybrid procedure has been proposed. We believe that certain types of VSD canbe closed safely by the transcatheter approach even if weight is less than 5kg, especially if the trendof miniaturizing devices continues. This approach should be considered as a valid alternative to asurgical option. We are reporting such a VSD baby with a weight of 2.3 Kg at the age of 6 months,which was closed with a duct occluder

scholarly journals Spontaneous Resolution of Residual Shunting in 2 Compromised Patients after Amplatzer Occlusion of Postinfarction Ventricular Septal Defects

2019 ◽  
Vol 46 (1) ◽  
pp. 44-47
Author(s):  
Takashi Yanagiuchi ◽  
Norio Tada ◽  
Taro Suchi ◽  
Yukiko Mizutani ◽  
Takashi Matsumoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Severe Heart Failure ◽  
Effective Management ◽  
Ventricular Septal Defects ◽  
Surgical Closure ◽  
Septal Defects ◽  
Gradual Disappearance ◽  
Intensively Managed

Ventricular septal defect (VSD) is a rare, potentially fatal complication of acute myocardial infarction. When surgical closure is contraindicated, transcatheter closure may be an alternative. Residual shunting after transcatheter closure of postinfarction VSDs has been reported; however, we found few cases of this in patients who also had severe heart failure or hemolysis. We report 2 closures of postinfarction VSDs with use of the Amplatzer Septal Occluder. Both elderly patients—one with severe heart failure, one with persistent hemolysis, and neither a surgical candidate—had high-velocity residual shunting through the occluders. We intensively managed the patients' conditions and used angiography and transthoracic echocardiography to record the gradual disappearance of each shunt over 4 months—the first such serial monitoring of which we are aware. We think that even substantial shunting in the presence of severe heart failure or hemolysis can eventually resolve spontaneously, assuming effective management of the concomitant medical conditions.

Prolonged Support with Intraaortic Balloon for Postinfarction Ventricular Septal Rupture

1994 ◽  
Vol 2 (2) ◽  
pp. 106-108
Author(s):  
Harinder Singh Bedi ◽  
Vijay Sharma ◽  
Vijay Kohli ◽  
Anil Mishra ◽  
Ashok Jayant ◽  
...  
Keyword(s):  
Septal Defect ◽  
Optimal Timing ◽  
Intraaortic Balloon ◽  
Ventricular Septal Rupture ◽  
Ventricular Septal Defects ◽  
Intraaortic Balloon Pump ◽  
Surgical Closure ◽  
Septal Defects ◽  
Early Closure ◽  
Postinfarction Ventricular Septal Rupture

The optimal timing of repair in postinfarct interventricular septal rupture remains controversial. We report a 53-year-old man with a postinfarct ventricular septal defect sustained on intraaortic balloon pump for 20 days before successful surgical closure. In the presence of proponents of routine early closure of postinfarct ventricular septal defects the possibility of prolonged intraaortic balloon pump support to stabilize the patient must be kept in mind.

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