title: Long-term results of primary closure for ventricular septal defects in the first year of life.
abstract: The long-term results of primary closure for large ventricular septal defects (VSDs) in infants under 1 year of age with severe symptoms were studied over a period of more than 10 years. Between January, 1971 and March, 1982, 49 infants underwent primary closure of a VSD through a right ventriculotomy using complete cardiopulmonary bypass with mild hypothermia. There were four hospital deaths but no late deaths. Two of four infants with residual shunts had a left ventricular-right atrial shunt which necessitated reoperation. Surgical heart block occurred in two infants who recovered sinus rhythm in the late period. The cardiothoracic ratio decreased from 60.5% preoperatively to 50.6% in the late postoperative period. Examination by cardiac catheterization revealed that the pulmonary-to-systemic pressure ratio (Pp/Ps) of 23 patients with a Pp/Ps of over 0.75 fell from 0.89 +/- 0.09 preoperatively to 0.42 +/- 0.12 by 1 month postoperatively, then to 0.27 +/- 0.05 in the late postoperative period. The latest values for the cardiac index and left ventricular ejection fraction were 3.4 l/min per m2 and 64.4%, respectively. More than 10 years after their operation, all the survivors were growing normally and maintaining a good quality of life, which supports our recommendation that primary repair should be performed in the first year of life for infants with large VSDs.
authors.affiliation: Department of Cardiovascular Surgery, Akita University School of Medicine, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Kuribayashi
authors.forename: S
authors.initials: S
authors.lastname: Sekine
authors.forename: H
authors.initials: H
authors.lastname: Aida
authors.forename: K
authors.initials: K
authors.lastname: Seki
authors.forename: A
authors.initials: A
authors.lastname: Meguro
authors.forename: Y
authors.initials: Y
authors.lastname: Shibata
authors.forename: T
authors.initials: T
authors.lastname: Sakurada
authors.forename: M
authors.initials: M
authors.lastname: Sato
authors.forename: T
authors.initials: T
authors.lastname: Abe
mesh_terms: D002037:Bundle-Branch Block / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D011788:Quality of Life; D015996:Survival Rate