scholarly journals A game of Whack-A-Mole: closing multiple ventricular septal defects

2021 ◽  
Author(s):  
Sandeep Sainathan ◽  
Leonardo Mulinari
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Failure ◽  
Heart Block ◽  
Clinical Problem ◽  
Congestive Cardiac Failure ◽  
Ventricular Septal Defects ◽  
Septal Defects

Multiple ventricular septal defects (m-VSD), are a challenging clinical problem. m-VSD can be onerous to manage. Besides the inability to close all the defects in one operative setting due to inadequate visualization, previously undetected defects may become clinically apparent after the closure of the dominant defects, leading to inadequate ventricular septation. This increases the morbidity from the progression of pulmonary hypertension, persistence of congestive cardiac failure, higher incidence of postoperative heart block, and the need for reoperations.

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

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..

scholarly journals Results of surgical treatment of ventricular septal defects with pulmonary hypertension.

Thorax ◽  
1983 ◽  
Vol 38 (4) ◽  
pp. 279-283 ◽  
Author(s):  
S John ◽  
R Korula ◽  
P S Jairaj ◽  
S Muralidharan ◽  
E Ravikumar ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Surgical Treatment ◽  
Ventricular Septal Defects ◽  
Septal Defects

scholarly journals Isolated Left Subclavian Artery, Multiple Ventricular Septal Defects and Pulmonary Hypertension In A Child: A Case Report

2021 ◽  
Author(s):  
Mohammadreza Khalilian ◽  
Manouchehr Hekmat ◽  
Saeed Sadr ◽  
Abdolhossein Tavallai-Zavvareh ◽  
Tahmineh Tahouri
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Subclavian Steal Syndrome ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Steal Syndrome

Abstract solated left subclavian artery is a rare congenital aortic arch anomaly in which the left subclavian artery is connected to the pulmonary artery via a patent Ductus Arteriosus or a remnant of it, instead of the arota. Generally, it is associated with the right aortic arch and other congenital heart defects, mostly tetralogy of Fallot. Isolated left subclavian artery can cause subclavian steal syndrome, pulmonary steal syndrome and size or blood pressure discrepancy between the two upper limbs. We present a 14-months-old infant with isolated left subclavian artery, multiple ventricular septal defects and pulmonary hypertension. To our knowledge, it is a rare anomaly which can influence the surgical planning and outcomes.

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