title: Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension.
abstract: Delayed presentation of ventricular septal defect (VSD) is common in developing countries. Such patients often have severe pulmonary arterial hypertension (PAH), which increases post-operative morbidity and mortality. To address these problems, we used our technique of unidirectional valved patch (UVP) for closure of VSD. Between January 2006 and December 2010, 17 patients (age 2-23 years, median 9 years) with a large VSD and severe PAH underwent VSD closure with UVP. Pre-operative mean indexed pulmonary vascular resistance (PVRI) was 10.9 ± 2.2 Wood units and mean pre-operative systemic saturation was 93.4 ± 2.6%. Shunt was bidirectional in 15 patients and predominantly right to left in two. After VSD closure, intra-operative transoesophageal echocardiography revealed a right to left shunt across the patch in three patients 2, 7 and 9 years of age who had pre-operative PVRI of 9.5, 9.8 and 11.1 Wood units, respectively. There were no in-hospital deaths and all patients had uneventful recovery. Mean follow-up was 30 ± 14.7 months and all patients are well without cyanosis. Echocardiography showed no shunt across the patch and all have systemic saturation >95%. We conclude that UVP is a promising technique in patients with large VSD and severe PAH.
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. sachintalwar@hotmail.com
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Choudhary
authors.forename: Sanket
authors.initials: S
authors.lastname: Garg
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.forename: Sivasubramanian
authors.initials: S
authors.lastname: Ramakrishnan
authors.forename: Shyam Sunder
authors.initials: SS
authors.lastname: Kothari
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D017548:Echocardiography, Transesophageal; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007194:India; D008297:Male; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance; D055815:Young Adult