Preoperative evaluation and surgery in isolated ventricular septal defects: a 21 year perspective

Objective-To study short and long term results after surgical closure of is olated ventricular septal defects (VSDs) from 1976 to 1996, especially in r elation to changes in preoperative evaluation during this period. Design-Retrospective study. Setting-Tertiary referral centre for paediatric cardiac care. Patients-All children under 18 years of age who had corrective surgery for VSD between 1976 and 1996. Main outcome measures-Preoperative evaluation, indications for surgery, dia gnostic errors, and early and late results. Results-A significant decrease in the use of invasive preoperative studies in favour of non-invasive methods was found; from 1976 to 1990, a total of 109/110 patients had preoperative invasive study as compared to 43/167 from 1991 to 1996 (p < 0.001). Pulmonary hypertension in small children, withou t detailed information on Qp:Qs ratio, as well as small or modest shunts wi thout. pulmonary hypertension, were more frequent indications for surgery i n recent years. Early mortality after surgery occurred in 10 patients, with a significantly lower mortality rate found between 1991 and 1996 than betw een 1976 and 1990 (0.6% v 8.2%, p < 0.001). Children with large VSDs experi enced perioperative complications significantly less often between 1991 and 1996 than between 1976 and 1990 (16/105 v 28/96, p < 0.05). Diagnostic err ors showed a tendency to decrease between the two time periods, No late dea ths occurred. Conclusions-Significant reductions in early mortality, perioperative compli cations, and diagnostic mistakes were seen during the study period, even th ough less invasive diagnostic procedures were being performed.