Multiple Ventricular Septal Defects

The Journal of Thoracic and Cardiovascular Surgery, 1998

The management of patients with multiple ventricular septal defects remains controversial. Primary closure, interventional catheter techniques, and palliative surgery all may have a role, and specific management guidelines remain undefined. Methods: We reviewed the records of all 33 patients with multiple ventricular septal defects undergoing repair between January 1988 and October 1996. Pulmonary artery hypertension was present in 21 patients (group 1), and pulmonary stenosis was present in the remaining 12 (group 2). Closure was accomplished from a right atriotomy alone in most patients, although an apical left ventriculotomy was used for apical defects. Among group 1 patients, the mean age at repair was 5.9 ؎ 0.9 months. Major associated anomalies included coarctation (n ‫؍‬ 6), straddling tricuspid valve (n ‫؍‬ l), and critical aortic stenosis (n ‫؍‬ 1). Reoperation was performed in two patients for residual ventricular septal defects. Among group 2 patients, the mean age at repair was 6.6 ؎ 3.2 years. Major associated anomalies included tetralogy of Fallot (n ‫؍‬ 2), pulmonary stenosis (n ‫؍‬ 4), double-outlet right ventricle with hypoplastic left ventricle (n ‫؍‬ 1), and isolated left ventricular hypoplasia (n ‫؍‬ 1). Three required reoperation for residual ventricular septal defect. Results: There were no early or late deaths, no episodes of heart block, and no significant residual ventricular septal defects among group 1 patients. All group 1 patients remain free of significant residual cardiovascular conditions at a mean of 23.4 ؎ 5.1 months. Among group 2 patients, there was one early death in a patient with double-outlet right ventricle and left ventricular hypoplasia. Complete heart block occurred in two patients and one required late mitral valve replacement. There were no late deaths, seven remain alive without significant residual defects at a mean of 36.2 ؎ 8.0 months, and two required transplantation for left ventricular failure. Conclusions: Primary repair for infants with multiple ventricular septal defects is associated with good late outcomes. The right atrial approach is satisfactory for most muscular defects, although limited apical left ventriculotomy was used for apical defects. Pulmonary artery banding should be limited to patients with complex associated defects. (J Thorac Cardiovasc Surg 1998;115:848-56)

Archives of disease in childhood, 2016

Ventricular septal defects (VSDs) are the most common congenital heart defects (CHDs). Previous studies indicate an increased risk of endocarditis, aortic regurgitation, left ventricular outflow tract obstructions, pulmonary hypertension, arrhythmias and sudden death in patients with isolated VSDs. The present nationwide cohort study reports mortality and cardiac complications requiring hospitalisation or intervention in children with isolated VSDs. Medical information concerning all 943 871 live births in Norway in 1994-2009 was retrieved from the Medical Birth Registry of Norway, the Cardiovascular Disease in Norway project, the Oslo University Hospital's Clinical Registry of Congenital Heart Defects and the Norwegian Cause of Death Registry. Isolated VSDs were identified in 3495 children without known chromosomal aberrations or extracardiac malformations. Surgical or catheter-based treatment of VSD was performed in 181 (5.2%) cases. Twelve (0.3%) children with VSDs died befor...

Journal of the American College of Cardiology, 2002

Journal of Evolution of Medical and Dental Sciences

BACKGROUND Ventricular Septal Defect (VSD) is the most common congenital heart disease in children. Our study was done with the aim to analyse the clinical profile and size and type of VSD in Paediatric patients admitted in a tertiary care hospital in Assam. METHOD This is a prospective cross-sectional study of 2 years' duration conducted in the Department of Paediatrics, Assam Medical College, Dibrugarh. Children aged 1 month to 12 years with a clinical diagnosis of VSD were evaluated by echocardiography to confirm the diagnosis. Only isolated VSD cases were enrolled in the study. Data was entered and analysed by SPSS version 16. RESULT Among the total of 70 cases, 47.1% were female and 52.9% were male; 54.3 % cases presented in infancy and 46 patients (65.7%) had their first symptom before one year. Perimembranous was the commonest (74.3%) followed by muscular (22.9%) and doubly committed subarterial (2.9%) VSD. Common symptoms were cough (68.6%), fever (68.6%), breathlessness (52.9%), feeding problem (45.7%), failure to thrive (45.7%) and fatigue (40%). Pansystolic murmur (100%), tachypnoea (62.9%), tachycardia (62.9%), crepitations (57.1%), subcostal retraction (45.7%), hepatomegaly (34.3%) and wheeze (20%) were the frequent clinical findings. Complications associated were pneumonia (57.1%), malnutrition (51.4%), congestive cardiac failure (CCF) (34.3%) and pulmonary hypertension (17.1%). CONCLUSION Perimembranous was the commonest type of VSD. Small VSD presented with mild symptoms or were asymptomatic. Moderate and large VSD presented with severe symptoms and complications. Clinical examination and diagnostic modalities like chest X-ray, ECG and echocardiography is helpful in diagnosing VSD. Early diagnosis and management will help in preventing the associated complications, thereby reducing the mortality and morbidity in these children.

Zenodo (CERN European Organization for Nuclear Research), 2021

Background: Ventricular septal defects (VSDs) are still one of the most prevalent surgical indications in newborns and children with congenital heart disease. With advances in echocardiography, cardiac catheterization is no longer necessary in the treatment of these individuals. Although perioperative mortality and morbidity for isolated defects are still low, unique scenarios such as surgical care of numerous VSDs and decision-making in patients with pulmonary hypertension remain difficult. This chapter examines both classic and recent evidence that has shaped the management of this condition, as well as the facts underlying developing interventional methods utilized in both the catheterization lab and the operating room. Conclusion: VSD is the most common congenital abnormality at birth. Small flaws should close on their own within the first year of life; however, larger faults can cause serious difficulties. The major interventions for big problems are surgical VSD closure and device closure.

2020

Cite as: Monzón Castillo EP, Tejada Martínez G. Isolated ventricular septal defect. A case report. Rev Peru Ginecol Obstet. 2020;66(3). DOI: https://doi.org/10.31403/rpgo. v66i2267 ABSTRACT Congenital heart disease is the most common congenital anomaly. Ventricular septal defect (VSD) is a frequent congenital heart disease in newborns, affecting 25 to 30% neonates with cardiac defects. Muscular VSDs are more frequent than perimembranous VSDs. The association of cases with chromosomal anomalies and isolated VSD is relatively low. Spontaneous closure of isolated VSD is higher with small VSD cases, and the muscular VSD is more likely to close spontaneously than the membranous or perimembranous types. Therefore, diagnosis of isolated muscular VSD with no other anomalies can be considered a benign finding.

European Journal of Cardio-Thoracic Surgery, 2003

Journal of Cardiac Surgery, 2013

Background: This study evaluated the outcomes of patients undergoing surgical repair of isolated ventricular septal defect (VSD) in the first year of life with particular attention to age and severity of pulmonary hypertension (PH). Methods: Between July 1, 2002 and May 31, 2012, 282 patients aged less than one year underwent isolated VSD closure at a median age of five months (range, 21 days to 1 year) and a median weight of 5.3 kg (range, 2.9 to 12.5 kg). Patients were divided into three groups according to the age at surgery (0-3, 3-6, and 6-12 months), and groups were compared in regard to severity of PH associated with morbidity and mortality. Results: Four (1.4%) early and four (1.4%) late deaths occurred postoperatively. All mortalities were patients with severe PH, aged between 3 and 12 months. Although hemodynamic studies revealed a higher incidence of persistent postoperative PH in patients above three months of age, there was no statistically significant difference in morbidity associated with prolonged mechanical ventilation, and long intensive care unit and hospital stays between age-related groups. Conclusion: In this study, the incidence of mortality was higher in patients over three months of age undergoing repair of isolated VSD; the data suggest that the mortality may be decreased in patients with severe PH who were operated on earlier in life. We conclude that in infants with severe PH, early surgical repair (less than three months) of isolated VSDs is strongly advised to achieve more favorable results.

Journal of Thoracic and Cardiovascular Surgery, 2004

Objective: This was an evaluation of a new approach to the management of multiple muscular ventricular septal defects. The defects were located with epicardial echocardiography, then transfixed with a guide wire inserted directly through the right ventricular free wall. They were closed with a custom-made multilayered doublepatch device under cardioplegic arrest through a standard right atriotomy. Methods: This was a retrospective study of 14 consecutive patients. Results: The median age and body weight at repair were 40 days (range 1 week-8 years, 3 months) and 4.1 kg (2.8-24 kg), respectively. Five patients (36%) had undergone at least one previous sternotomy; 11 patients (78%) had associated cardiac lesions. Closure of the multiple septal defects was successful in 12 patients (85%). Failure to localize all defects led to pulmonary artery banding in 2 patients. One patient had the residual septal defect closed with a percutaneous device 6 months later, and in the second patient the residual defect was closed with a conventional approach 11 months afterward. Two patients had permanent pacemaker insertion. In 279 patient-months of follow-up, there was 1 cardiac arrest on day 1 and no early or late deaths; all children but one are free of cardiac medications, and no significant residual left-to-right shunts were demonstrated in any patient. Conclusion: The reported management of multiple ventricular septal defects has been successful in this series, even in neonates and infants with complex associated cardiac lesions. It appears safe, simple, and effective. T he management of patients with multiple ventricular septal defects (VSDs) remains a surgical challenge, with primary surgical repair to avoid palliation increasingly favored. 1-3 In the neonate and infant, primary repair can be demanding. The intraoperative identification of muscular defects is difficult through the right atriotomy. Often this requires long aortic crossclamp and cardiopulmonary bypass (CPB) times and right or left ventriculotomies. Left ventriculotomies have long-term complications. 4,5 Eventually some VSDs may never be found, despite extensive resection of muscular trabeculations, and may generate large residual shunts. Alternately, the initial palliation with pulmonary artery banding has inherent morbidity From the Cardiac Surgery Unit and Depart

JPMA. The Journal of the Pakistan Medical Association, 2011

To determine the frequency of various types of ventricular septal defects (VSD) and associated complications in local paediatric population. A cross sectional descriptive study was conducted on children undergoing echocardiography in a single centre from January 2006 to December 2009 at Paediatric Cardiology Department, Ch. Pervaiz Elahi Institute of Cardiology Multan- Tertiary referral centre for paediatric and adult cardiac services in South Punjab. The data on all children below 15 years of age undergoing detailed transthoracic two-dimensional echo and Doppler studies was reviewed. Cases with isolated ventricular septal defects were studied for age of presentation, gender, type, and associated complications. The data was analyzed with SPSS 11 version. A total of 5018 patients with congenital heart diseases underwent echocardiography during this period. A total of 1276 patients had isolated VSD (25%). Mean age was 3.1 +/- 3.64 years (range: 1 day to 15 years). Females were 440 (34...