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. 2019 Nov 25;12(4):121-124.
eCollection 2019 Nov.

The Early "Unnatural" History Following Surgical Repair of Ventricular Septal Defects

Sathish M Chikkabyrappa  1 , Justin T Tretter  2 , Arpan R Doshi  3 , Sujatha Buddhe  1 , Puneet Bhatla  4 , Achi Ludomirsky  4
Affiliations

The Early "Unnatural" History Following Surgical Repair of Ventricular Septal Defects

Sathish M Chikkabyrappa et al. Kans J Med. .

Abstract

Introduction: Surgical outcomes for simple ventricular septal defects (VSD) have been excellent in the past three decades. For this project, the timing of resolution of left-sided dilation and mitral regurgitation (MR) following VSD repair was assessed.

Methods: Echocardiographic data surrounding surgery of 42 consecutive children who underwent surgical patch repair of a VSD were reviewed. The echocardiograms were reviewed up to a mean of 12 months post-operatively (range 9 - 14 months). Quantitative data indexed to body surface area including left atrial (LA) volume, mitral valve annulus diameter, and left ventricular end-diastolic dimension (LVEDD) was analyzed.

Results: The majority of our pre-surgical cohort had only trace (44%) or no MR (31%), with a small proportion having mild (16%) or moderate MR (9%). No patients had moderate or greater MR following repair at follow-up. The median mitral valve annular Z-score was 1.8 (SD 1.6; range: -1.2 to 4.1) pre-operatively, improving to a 0.6 (range: -1.7 to 2.4; p < 0.001) at follow-up. LA dilation was present in 70% of patients, with a median LA volume Z-score of 1.1 (range: -2.6 to 15.5), decreasing to 13% median Z-score -1.2 (range: -3.5 to 2.9; p < 0.001) at follow-up. LV dilation was present in 81% of pre-operative patients with a median LVEDD Z-score of 3.0 (range: -2.0 to 7.9). There was significant improvement in qualitative assessment of LV enlargement (25%) with a median LVEDD Z-score of 0.5 (range: -2.1 to 2.9; p < 0.001) at follow-up. Discharge echocardiogram was performed at a mean of 5.7 days (range: 3 - 12 days) following surgery.

Conclusions: Normalization of LA, mitral valve annulus, and LV size occurred within the first three months in the majority of patients, with significant changes occurring within the first post-operative week following surgical repair for VSD.

Keywords: congenital heart defect; dilations; mitral regurgitation; pediatrics; ventricular heart septal defect.

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Figures

Figure 1
Figure 1
Mitral valve annulus Z-score surrounding ventricular septal defect surgical repair. The solid black slope represents the median change from pre-op to follow-up mitral valve Z-score (slope −0.4, p = 0.02).
Figure 2
Figure 2
Left atrial volume Z-score surrounding ventricular septal defect surgical repair. The solid black slope represents the mean change from pre-op to follow-up LA volume Z-score (slope −1.4, p = 0.01).
Figure 3
Figure 3
Left ventricular end-diastolic dimensions score surrounding ventricular septal defect surgical repair. The solid black slope represents the mean change from pre-op to follow-up LVEDD Z-score (slope −1.2, p = 0.01).
See this image and copyright information in PMC

References

    1. Rubio AE, Lewin MB. Ventricular Septal Defects. In: Allen HD, Driscoll DJ, Feltes TF, Shaddy RE, editors. Moss and Adams’ Heart Disease in Infants, Children, and Adolescents. 8th Edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. pp. 713–721.
    1. Senzaki H, Kumakura R, Ishido H, Masutani S, Seki M, Yoshiba S. Left atrial systolic force in children: Reference values for normal children and changes in cardiovascular disease with left ventricular volume overload or pressure overload. J Am Soc Echocardiogr. 2009;22(8):939–946. - PubMed
    1. Jonas R. Ventricular Septal Defect. In: Jonas R, editor. Comprehensive Surgical Management of Congenital Heart Disease. London, UK: Hooper Arnold Publication; 2004. pp. 242–255.
    1. Pacileo G, Pisacane C, Russo MG, et al. Left ventricular mechanics after closure of ventricular septal defect: Influence of size of the defect and age at surgical repair. Cardiol Young. 1998;8(3):320–328. - PubMed
    1. Yoshikawa M, Sato T. Left ventricular end-systolic wall stress to volume relationship before and after surgical closure of ventricular septal defect. Pediatr Cardiol. 1987;8(2):93–98. - PubMed

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