EARLY SURGICAL CORRECTION OF LARGE VENTRICULAR SEPTAL DEFECTS

Abstract

A significant number of babies born with large ventricular septal defects present early in life as problems in management of congestive heart failure, severe pulmonary hypertension, marked growth retardation, and recurrent pulmonary infections. Review of patients born since December 1954 with ventricular septal defects and followed at our institution allowed for comparison between infants treated surgically and those patients treated either medically or requiring no specific therapy. In 45 infants direct surgical closure of the ventricular defect was undertaken when supportive medical management alone appeared to be inadequate to insure survival or a normal life potential. There was an 80% survival with surgery. All 9 deaths occurred in patients having severe pulmonary hypertension; in some instances additional factors were believed to have contributed to the death of the infant. Nonetheless, surgical mortality appeared to be lower in the infants having severe pulmonary hypertension than among children with a comparable degree of hypertension who were operated on over the age of 2 years. Postmortem examination revealed pathologic changes of advanced pulmonary vascular obstructive disease at as early an age as 8 months. Direct surgical closure of the ventricular septal defect was chosen in preference to the pulmonary artery handing procedure because it not only offers an immediate means of helping the sick infant but also should obviate the necessity of a second major surgical procedure when the patient is older. It is further anticipated that early correction of the septal defect will prove effective in many instances in preventing the serious consequences of pulmonary hypertension.