Early surgical closure of a large ventricular septal defect: Influence on long-term growth

Abstract

The pre- and postoperative growth patterns or 52 otherwise normal infants undergoing primary surgical closure of a large ventricular septal defect before 7 months of age were reviewed. Serial measurements of weight, length and head circumference were compiled for all patients preoperatively and in 46 long-term survivors and were expressed as Z scores (in standard deviations from the mean for age and gender).By the time of surgery at a mean age of 0.33 year, the mean weight, length and head circumference Z scores of all 52 infants were −2.9, −0.9 and −0.6, respectively, and were all significantly below normal (p < 0.001). At a mean age of 5.7 years, the mean weight, length and head circumference Z scores of 35 patients of normal birth weight were normal or varied only marginally from those of the reference population (−0.4, −0.1 and +0.5, respectively: p < 0.02, p > 0.05 and p = 0.008, respectively) and did not differ significantly in any variable from those of 44 normal siblings. However, among 11 infants with a low birth weight, all three variables remained abnormal at long-term follow-up when compared with the reference population (−1.7, −1.7 and −0.9, respectively; p < 0.001 for each) and 22 normal siblings (p < 0.008). The difference between pre- and postoperative Z scores was highly significant (p ≤ 0.004) for all three variables in the normal birth weight group, but only a significant difference in weight Z scores emerged in the low birth weight group (p < 0.001). Catch-up growth in most cases was complete within 6 to 12 months after operation.Early surgical repair of a large ventricular septal defect results in near normal long-term growth in the majority of patients. Residual growth disturbances are usually due to extracardiac factors. The present results support a policy of early surgical intervention in infants with a large ventricular septal defect.