Follow-up after surgical closure of congenital ventricular septal defect

• Published in: European journal of cardio-thoracic surgery Vol. 24; no. 4; pp. 511 - 515
• Main Authors: Bol-Raap, G., Weerheim, J., Kappetein, A.P., Witsenburg, M., Bogers, A.J.J.C.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01-10-2003; Elsevier Science
• Subjects: Adolescent; Biological and medical sciences; Cardiac Surgical Procedures - methods; Cardiology. Vascular system; Child; Child, Preschool; Congenital; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Female; Follow-Up Studies; Heart; Heart Septal Defects, Ventricular - surgery; Hospital Mortality; Humans; Infant; Infant, Newborn; Logistic Models; Male; Medical sciences; Recurrence; Retrospective Studies; Risk Factors; Surgery; Treatment Outcome; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - etiology; Ventricular septal defect; Ventricular septal defect; Congenital; Surgery; Follow-up studies; Ventricular septal defect: Congenital; Cardiovascular disease; Intracardiac defect; Congenital disease; Surgical closure; Treatment; Malformation; Follow up study; Heart disease
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(03)00430-5

Objectives: The purpose of this retrospective study was to assess long-term outcome of children after surgical closure of a ventricular septal defect (VSD). Material and methods: Between January 1992 and December 2001 a consecutive series of 188 patients (100 females) were operated for closure of a VSD. Temporary tricuspid valve detachment (TVD) was applied in 46 patients (24%) to enhance exposure of the defect using transatrial approach. Pre-operative baseline characteristics showed that the detached group was younger (0.79±1.8 vs 2.1±3.5 years, p=0.002) and had a lower weight (6.5±6.4 vs 10.0±11.0 kg, p=0.009). Results: There was no difference in cross-clamp time (temporary TVD 36.2±11.3 vs non-temporary TVD 33.6±13.1 min, p=0.228). Postoperative echocardiography showed that 67 patients (36%) had trivial/minimal regurgitation, 10 patients (22%) from the temporary TVD group vs 57 patients (40%) from the non-detached group (p=0.02). There was no tricuspid stenosis. Hospital mortality comprised two patients (1%). One patient died due to a pulmonary hypertensive crisis and one in relation to an acute patch dehiscence for which an emergency reoperation was necessary. At first postoperative echocardiography no shunting was detected in 113 patients, trivial shunting in 73 and significant shunting in none. Multivariate logistic regression analysis revealed that weight at operation was a predictive factor for the occurrence of residual shunting (OR 0.95, C.I. 0.91–0.99). One patient with conduction disturbances needed a permanent DDD-pacemaker. Three patients were lost to follow-up. Mean follow-up time was 2.6 years (range 0.1–9.4). During follow-up no reoperations were necessary for closing a residual VSD. One patient died 7 months postoperative due to a bronchopneumonia. During follow-up in 37 (51%) of the 73 patients the trivial shunting disappeared spontaneously at a median time of 3.9 years. According to actuarial analysis all trivial shunting had disappeared at 8.4 years. Conclusion: Trivial residual shunting disappeared spontaneously at a median follow-up time of 3.9 years. During follow-up no patient needed to be reoperated for residual VSD. TVD proved to be a safe method to enhance the exposure of a VSD.