Valve patch technique for repair of ventricular septal defect: long-term results

Abstract

Objective

This study aimed to show the long-term results in patients who underwent unidirectional valve patch repair of ventricular septal defect with pulmonary artery hypertension.

Methods

Thirty-five acyanotic patients aged 2 to 26 years (mean 9.3 years) with a large ventricular septal defect and elevated pulmonary vascular resistance (mean 9.5 Wood units) underwent surgery in Madani Heart Hospital. The medical records and clinical outcomes were reviewed from March 1998 to March 2017.

Results

Five patients died in the first postoperative week. In the long-term follow-up (mean 11 years), two patients were lost to follow-up. Pulmonary artery hypertension gradually decreased in 17 patients within 6–12 months with significant improvement in right ventricular end-diastolic diameter, New York Heart Association functional class, and tricuspid regurgitation. Eleven patients with persistent pulmonary artery hypertension were divided into tolerable and non-tolerable groups. Six patients in the tolerable group had satisfactory conditions compared to before the operation, and gained weight with improved functional class despite echocardiographic findings of persistent elevated pulmonary artery pressure. One had a full-term delivery by caesarean section in the fifth postoperative year. Five patients in the non-tolerable group gradually developed right heart failure and complications such as extremity edema, ascites, pleural effusions, and died after 10–30 months.

Conclusion

Although relatively high mortality occurred during long-term follow-up, surviving patients were in a better condition and functional class despite persistent pulmonary artery hypertension. Therefore, fear of persistent pulmonary artery hypertension should not prohibit surgery in this group of patients.

Keywords

Cardiac surgical procedures,ventricular septal defect,pulmonary artery hypertension

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References

Novick

Sandoval

Lazorhysynets

, et al. Flap valve double patch closure of ventricular septal defects in children with increased pulmonary vascular resistance. Ann Thorac Surg 2005; 79: 21–28.

Zhou

Lai

Wei

Song

Yafeng

Zhang

Unidirectional valve patch for repair of cardiac septal defects with pulmonary hypertension. Ann Thorac Surg 1995; 60: 1245–1248.

Zhang

Liang

, et al. Unidirectional monovalve homologous aortic patch for repair of ventricular septal defect with pulmonary hypertension. Ann Thorac Surg 2007; 83: 2176–2181.

Afrasiabi

Samadi

Montazergaem

Valved patch for ventricular septal defect with pulmonary arterial hypertension.

Asian Cardiovasc Thorac Ann 2006; 14: 501–504.

Demirag

Keceligil

Kolbakir

Primary surgical repair of ventricular septal defect.

Asian Cardiovasc Thorac Ann 2003; 11: 213–216.

Gan

Zhang

Luo

Zhou

The unidirectional valve patch provides no benefits to early and long-term survival in patients with ventricular septal defect and severe pulmonary artery hypertension.

J Thorac Cardiovasc Surg 2010; 139: 950–955.

Downing

Edmunds

Jr.

Release of vasoactive substances during cardiopulmonary bypass.

Ann Thorac Surg 1992; 54: 1236–1243.

Schulze-Neick

Penny

Redington

AN.

Pulmonary vascular resistance after cardiopulmonary bypass in infants: effect on postoperative recovery. J Thorac Cardiovasc Surg 2001; 121: 1033–1039.