INDICATIONS AND SURGICAL RESULTS OF 50 IS OLATED VENTRICULAR SEPTAL-DEFECTS

Surgical indications of isolated ventricular septal defects (VSD) with large shunts are a common problem in paediatric cardiology. The prese nt study was undertaken retrospectively and continuously over 5 years in 50 patients in whom the age of diagnosis varied from birth to 1 yea r. The surgical results are presented and the clinical and paraclinica l parameters used for determining the surgical indications are reviewe d. Only 16 out of 50 children (32 %) were operated without catheter st udy. However, since February 1992, when colour Doppler echocardiograph y became a routine investigation in the department, 75 % of children h ave been operated on echocardiographic data alone. Knowing that the ri sk of pulmonary vascular disease is practically nil in this condition at this age, the most important problem lies in distinguishing between single and multiple VSDs. Until recently, angiography has always been the reference investigation. In this series, it did not appear to be superior to a good colour Doppler study. The surgical results showed a hospital mortality of 4 %, the persistence of a well tolerated VSD in 16 % of cases, none of which required reoperation. Two cases of compl ete atrioventricular block required permanent cardiac pacing. The auth ors conclude that when echocardiography provides all the necessary dat a concerning site, number, size and haemodynamic consequences of VSD, catheterisation may be dispensed with at this age. The surgical indica tion is, generally, closure of the VSD by a patch, usually possible by a right atrial approach; pulmonary artery banding is an exceptional n ecessity in infants with a precarious haemodynamic status and/or with multiple apical VSD.