Issa Saleh Hijazi, Fakhri Ahmad Alhakim.
Hemodynamic changes and outcome after surgical closure of Ventricular Septal Defect in infants.
Pak J Med Sci Jan ;21(1):17-21.

Objective: This study aimed to review a ten years experience of surgical closure of ventricular septal defect in infants, assessing the postoperative clinical and hemodynamic results. Patients and Methods: During the study period between Jan 1991 to Jan 2001,a total of 153 patients aged less than two years, underwent surgical closure of ventricular septal defect. Follow up evaluation include clinical symptoms, electrocardiogram, 2-dimensional echocardiography and cardiac catheterisation. The main indications for follow up cardiac catheterisation were: persistent respiratory symptoms, a clinical or echocardiography signs of residual leak across the VSD and improper weight gain. Results: Follow up was completed in 150 patients. Cardiac catheterisation was performed in 42 patients. 132 patients (88.0%) had complete resolution of their preoperative symptoms. Complete closure of the ventricular septum was achieved in 115 patients (76.6%). 28 patients (18.7%) had small residual leak across the septum, 6(4%) patients had significant leak across the septum and needed a second operation to close the defect, and five patients (3.3%) had small leak and mild pulmonary hypertension, but the calculated left to right shunt was <1.5:1 and they needed medical treatment for one year. Persistent severe pulmonary hypertension was noticed in one patient who underwent atria[ septostomy. The mean pulmonary arterial pressure dropped from 60 mmHg to 27 mmHg. Three patients (2.0%) had complete heart block and needed an insertion of permanent pacemaker. The hospital mortality of the entire group was 1.30 % and there was no late mortality. Conclusion: Surgical closure of ventricular septal defects at an early age resulted in resolution of symptoms, satisfactory 2-dimensional echocardiography and Doppler findings and further reduction in pulmonary artery pressure as early as three months in most patients.

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