Closure of Ventricular Septal Defects during Infancy*

Summary

Fifty-four infants (under the age of one year) with ventricular septal defect (VSD) as their predominant lesion were operated upon from 1974 to 1979 using conventional cardio-pulmonary bypass and moderate total body hypothermia. Indications for early closure were cardiac failure resistant to maximal medical treatment, failure to thrive, and/or recurrent respiratory infections. A rising pulmonary vascular resistance was also considered an indication for primary repair. There was one hospital death, another fatality occurring 6 weeks after surgery, amounting to a total mortality of 4 %. Most of the complications (prolonged respirator treatment, various types of heart block) occurred in patients operated upon at ages less than 3 months (n = 9).

On the basis of this experience early closure of VSD is recommended regardless of age, except in cases with multiple defects where first-stage pulmonary artery banding is preferred. Primary banding was unsuccessful in 3 of 4 patients suffering from the combination of VSD and coarctation of the aorta operated upon before the third month of life. Our present policy in VSD plus coarctation or patent ductus arteriosus is to repair the extracardiac lesion first, without constricting the pulmonary artery. The defect is closed promptly if the patient fails to improve and has to remain on respirator treatment. The right atrial approach for closure of solitary VSD of all types in recommended and appears feasible in the great majority of patients, particularly when cardioplegia is used.

Key words

Ventricular septal defect - Closure in infancy