INTRACARDIAC REPAIR OF LARGE VENTRICULAR SEPTAL DEFECT IN THE FIRST YEAR OF LIFE

Abstract

Primary intracardiac repair of large ventricular septal defects with severe pulmonary hypertension has been performed in 28 infants in the first year of life. All infants were failing to thrive and suffered from severe cardiac failure resistant to medical therapy or had evidence of early pulmonary vascular disease. Age at operation was between six weeks and 11 months with 15 patients under six months of age. The smallest survivor weighed 3 · 0 kg. Three patients died, giving an overall operative mortality of 10·7% Twenty‐five patients had a single ventricular septal defect and two died, an operative mortality of 8%. Three patients had multiple ventricular septal defects and one died after operation. Four patients had an associated persistent ductus arteriosus and three had secundum type atrial septal defects requiring concomitant closure. Twenty‐five survivors have been followed for up to two years. Ali are thriving and have normal or mildly enlarged hearts on chest X‐ray examination. Primary intracardiac repair of large ventricular septal defects can be performed in the first year of life with a low operative risk when managed by an experienced paediatric cardiac team. Under these circumstances the palliative management of such patients by pulmonary artery banding is now obsolete.