Repair of Large Ventricular Septal Defects in Infants and Small Children

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Abstract
It is possible to achieve excellent results for primary closure of ventricular septal defects regardless of the age of the patients when surgical intervention is required. Severely symptomatic patients (32), age 1-24 mo. with large ventricular septal defects (.hivin.m Qp/Qs[mean left-to-right shunt] = 3.4, .hivin.m R VSD [mean ventricular septal defect resistance index] = 4.0), had primary repair of the defects with 1 (3%) hospital death. Seven patients (22%) had increased pulmonary vascular resistance ranging from 5.4-12 U/m2. It was possible to close the ventricular septal defect through the right atrium in 26 patients (81%). Pulmonary artery banding was not performed in any patient with isolated ventricular septal defect during the period of this study. The 31 survivors were followed an average of 4 yr, and 30 of them are remarkably improved and remain New York Heart Association Class I or II. Only 1 patient, with obstructive pulmonary vascular disease (pulmonary resistance = 12 U/m2), died suddenly 16 mo. after operation. Follow-up catheterization was offered to all patients, with 18 (60%) being restudied. These hemodynamic data show that pulmonary vascular resistance after surgery is usually normal or only minimally elevated; except for 1 patient with a large residual ventricular septal defect, functionally significant left to right shunts were eliminated. These results and the analysis of results of combined series reported in the literature for primary and staged operations for large ventricular septal defects lend further support for the continued practice of primary repair of isolated large ventricular septal defects in infants and children who require surgery.