title: Management of infants with large, unrepaired ventricular septal defects and respiratory infection requiring mechanical ventilation.
abstract: OBJECTIVE
  We sought to describe the hospital management and early outcome of critically ill infants presenting with large ventricular septal defects and pneumonia requiring mechanical ventilation at a referral center in a developing country. Infants with large ventricular septal defects who have pneumonia might present with respiratory failure requiring mechanical ventilation. In the developing world this presentation is relatively common, but few data exist describing patient management strategies.
  
  
  METHODS
  Hospital data of consecutive infants admitted with large ventricular septal defects and pneumonia requiring mechanical ventilation were reviewed and analyzed.
  
  
  RESULTS
  We identified 18 infants (mean age, 3.6 +/- 3.0 months). On admission, all the infants were significantly malnourished, and echocardiography showed bidirectional shunting (predominantly right-to-left shunting) in 6 infants. Thirteen (72%) patients improved with intensive medical management that included mechanical ventilation for 1 to 16 days (median, 6.5 days); unequivocal left-to-right shunting was subsequently documented by means of echocardiography in all 13 patients. Twelve patients underwent surgical repair, and 11 (91.6%) were discharged after median mechanical ventilation of 100 hours (range, 42-240 hours) and intensive care unit stay of 8 days (range, 4-15 days). Five of 6 unoperated patients died, 4 of them within a few hours of admission. One child with multiple ventricular septal defects was discharged and subsequently underwent pulmonary artery banding.
  
  
  CONCLUSIONS
  Corrective cardiac surgery for selected critically ill infants with large ventricular septal defects, severe malnutrition, and pneumonia requiring mechanical ventilation is feasible and should be considered a viable management strategy.
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Bhatt
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.forename: R Krishna
authors.initials: RK
authors.lastname: Kumar
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Suresh G
authors.initials: SG
authors.lastname: Nair
authors.forename: Suresh
authors.initials: S
authors.lastname: Chengode
authors.forename: Krishnanaik
authors.initials: K
authors.lastname: Shivaprakasha
authors.forename: Suresh G
authors.initials: SG
authors.lastname: Rao
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004452:Echocardiography; D006343:Heart Septal Defects / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000150:complications; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000628:therapy; D011182:Postoperative Care; D011183:Postoperative Complications; D012121:Respiration, Artificial
chemical_list: D000900:Anti-Bacterial Agents