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Nakayama Y, Horimoto Y, Suzuki K, Takiguchi M, Ishihara K, Umehara N, Shinkawa T. Clinical Course of Residual Ventricular Septal Defects After Congenital Heart Disease Repair. Pediatr Cardiol 2024:10.1007/s00246-024-03542-5. [PMID: 38916670 DOI: 10.1007/s00246-024-03542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
The clinical course of residual ventricular septal defects after congenital heart disease repair is not completely elucidated in the medical literature. This study assessed the incidence, size, and clinical course of residual defects.This single-center retrospective study included 132 patients who survived after ventricular septal defect patch closure (n = 107) and intracardiac repair of double-outlet right ventricle (n = 16) and tetralogy of Fallot (n = 9). Residual defect was evaluated on transthoracic echocardiogram upon hospital discharge and at outpatient clinic visits.The median age at surgery was 1.2 (0.3-13.9) years. In total, 45 (34.1%) patients presented with residual defects upon hospital discharge. The residual defects were within 2 mm (n = 27), 2-3 mm (n = 15), and > 3 mm (n = 3), and the median size was 1.5 (0.5-3.8) mm. There was no late mortality during a median follow-up of 5.4 years. Among 42 residual defects measuring < 3 mm upon hospital discharge, 37 (82.2%) spontaneously closed. Further, five defects decreased in size (1.8 ± 0.6 mm upon hospital discharge vs1.2 ± 0.8 mm at the latest visits, p = 0.15). However, the size of three residual defects measuring > 3 mm upon hospital discharge increased, and two patients required re-surgery for residual defect.Significant residual defect requiring reoperation was rare. In most cases, residual defects measuring < 3 mm upon hospital discharge spontaneously closed within 5 years, and the size of the other defects decreased.
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Affiliation(s)
- Yuki Nakayama
- Department of Pediatric Cardiovascular Surgery, Matsudo City General Hospital, 993-1, Sendabori, Matsudo, Chiba, 270-2296, Japan.
| | - Yoshihiko Horimoto
- Department of Pediatrics, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Kazuhiro Suzuki
- Department of Pediatrics, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Makoto Takiguchi
- Department of Pediatric Cardiovascular Surgery, Matsudo City General Hospital, 993-1, Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Kazuaki Ishihara
- Department of Pediatric Cardiovascular Surgery, Matsudo City General Hospital, 993-1, Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Nobuhiro Umehara
- Department of Cardiovascular Surgery, Matsudo City General Hospital, 993-1, Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Takeshi Shinkawa
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
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Faraji E, Bolin EH, Bond EG, Thomas Collins R, Greiten L, Daily JA. Left Ventricular Dysfunction Following Repair of Ventricular Septal Defects in Infants. Pediatr Cardiol 2024:10.1007/s00246-023-03391-8. [PMID: 38236399 DOI: 10.1007/s00246-023-03391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
Left ventricular systolic dysfunction (LVSD) is frequently observed following repair of ventricular septal defects (VSD), although little is known about its incidence, time course, or risk factors. Among infants undergoing VSD repair, for postoperative LVSD, we sought to determine (1) incidence, (2) predictors, and (3) time to resolution. We queried our institution's surgical database for infants who underwent repair of isolated VSDs from November 2001 through January 2019. The primary outcome was postoperative LVSD, which was defined as a shortening fraction (SF) of <26% by M-mode. Postoperative echocardiograms were reviewed, and measurements were made using standard methods. Receiver operating characteristic analysis was generated to determine the preoperative left ventricular internal dimension (LVIDd) z-score most predictive of LVSD. Multivariable analysis was conducted to determine associations with LVSD; covariates in the model were weight percentile, genetic syndrome, preoperative diuretic, VSD type, and preoperative LVIDd z-score. Of the 164 patients who met inclusion criteria, 62 (38%) had postoperative LVSD. Fifty-eight (94%) of patients had resolution of LVSD within 9 months of surgery. Preoperative LVIDd z-score of >3.1 was associated with both an increased incidence of postoperative LVSD and prolonged time to resolution. Multivariable logistic regression analysis showed only preoperative LVIDd z-score was independently associated with postoperative LVSD. LVSD following VSD closure is common, but nearly all cases resolve by 9 months postoperatively. Elevated LVIDd prior to surgery is associated with postoperative LVSD. These data suggest VSD closure should be considered prior to the development of significant left ventricular dilation.
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Affiliation(s)
- Ehssan Faraji
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elijah H Bolin
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
| | - Elizabeth G Bond
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Thomas Collins
- University of Kentucky College of Medicine, Lexington, KY, USA
- Kentucky Children's Hospital, Lexington, KY, USA
| | - Lawrence Greiten
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
| | - Joshua A Daily
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA.
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