Two-Stage Treatment of Ventricular Septal Defect with Pulmonary Hypertension

Abstract

entricular septa1 defect is the most common congenital cardiac lesion. The closure of simple ventricular defects has been perV formed with a very low mortality. In contrast, the results of surgical correction of ventricular defects with pulmonary hypertension have been generally unfavorable despite improved knowledge of cardiac physiology, surgical technique, and postoperative care. Muller and Dammann [13, 141 were the first successfully to employ constriction of the pulmonary artery as a palliative procedure for patients with a large left-to-right intracardiac shunt. In the era of complete correction of congenital cardiac defects under direct vision using heartlung bypass, pulmonary artery banding has been accepted by many cardiac surgeons for the treatment of infants with ventricular defects and pulmonary hypertension. We have employed a two-stage operation, with pulmonary artery banding as the first stage and closure of the ventricular defect as the second. We have used this operation not only for infants but also for older children to reduce the high surgical mortality from primary surgical closure [ 19-2 11. Since reports of second-stage correction of the ventricular defect and artifically constricted pulmonary artery have been scant [3, 5, 12, 161, we have reviewed our experience with the two-stage operation in treating infants and children with ventricular defects and pulmonary hypertension to define the role of this approach.