Septal Defect In Infants Research Articles

Prospective identification of ventricular septal defects in infancy using subxiphoid two-dimensional echocardiography.

The objective of this study was to establish a dependable technique for imaging the interventricular septum and ventricular septal defects in infants. Subxiphoid two-dimensional echocardiograms were performed on 81 infants who were 1 day to 12 months (median 43 days) old and weighed 1.6-8.6 kg (median 3.4 kg). A short-focus, 5-MHz crystal with a 13-mm active element diameter was used in all studies. The interventricular septum was visualized in 80 of 81 infants. Defects in the membranous, atrioventricular canal, conoventricular and muscular segments of the sentum were identified using three standard transverse subxiphoid projections. All defects in the membranous and atrioventricular canal segments, as well as malalignment type conoventricular communications, were correctly identified when compared with selective angled cineangiocardiography. Only two of the three subpulmonic and four of 11 muscular defects were identified successfully. Limitations in imaging defects in the muscular septum reflected the varied morphology of these interventricular communications and the tangential orientation of the echo beam to the extreme apical and anterior segments of the muscular septum.

Simplified method for total correction of interrupted aortic arch with ventricular septal defect in infancy

Type A interrupted aortic arch with a ventricular septal defect (VSD) in a 3-month-old infant was successfully corrected with the aid of profound hypothermia, limited cardiopulmonary bypass, and total circulatory arrest. The aortic arch was reconstructed by side-to-side anastomosis of the ascending aorta and the main pulmonary artery and then creation of a tube from the anastomotic orifice to the patent ductus arteriosus (PDA) by using a superabundant flap of the anterior wall of the main pulmonary artery. The pulmonary arteriotomy and VSD then were closed. The operative field can be approached easily through a median sternotomy with minimum dissection. Cardiac catheterization and angiocardiography 2 months later demonstrated a satisfactory reconstruction of both the aortic arch and the pulmonary artery.

Deep hypothermic arrest: Observations on later development in children

Thirty-two children were reviewed following closure of ventricular septal defect in infancy. Fifteen had undergone continuous perfusion and 17 had been subjected to core cooling followed by deep hypothermic arrest. Parental and professional evaluations of intellectual and motor development, at periods between 7 and 72 months following operation, suggest that there is a higher incidence of developmental abnormality in the subgroup treated with deep hypothermic arrest.

Surgical treatment of ventricular septal defect in infancy. Primary repair versus banding of pulmonary artery and later repair.

Results of primary closure of ventricular septal defects are compared with those of two-stage repair, with banding of the pulmonary artery followed by debanding and closure. Apart from the high incidence of unsatisfactory results after banding and a significant morbidity with the two-stage approach, the mortality for primary repair (2.4%) is considerably lower than that achieved with the staged repair (19.3%). Primary repair of ventricular septal defect is advocated for infants resistant to maximal medical treatment. A more flexible policy is adopted for patients with multiple ventricular septal defects and those with associated anomalies.

Ventricular septal defect in infancy: a combined vectorgraphic and echocardiographic study.

Echocardiograms (echo) and vectorcardiograms (VCG) from 40 infants with ventricular septal defects (VSD) were compared with cardiac catheterization data to assess noninvasively the hemodynamics of VSD. The specific aim was to use VCG parameters of right ventricular hypertrophy and echo parameters which reflect pulmonary artery pressure to identify all patients with a nonrestrictive VSD. The configuration of the QRS vector in the horizontal plane was more reliable than individual voltages in assessing right ventricular systolic pressure. Among patients older than 2 months with a clockwise or anterior two-main-vector horizontal loop, 73% (eight of 11) had a nonrestrictive VSD. However, a counterclockwise or posterior two-main-vector loop was also frequently found (43%, six of 14) in infants with a nonrestrictive VSD. The most useful echo parameter was the ratio of right ventricular preejection period-to-right ventricular ejection time (RPEP/RVET), which closely (r = 0.74) reflected the pulmonary artery diastolic pressure. An elevated RPEP/RVET to greater than 0.30 was always associated with a nonrestrictive VSD, although many patients (36%, five of 14) with a nonrestrictive VSD had a normal ratio. By combining both echo and VCG parameters, a nonrestrictive VSD was correctly identified in all patients, while a restrictive VSD was correctly identified in 81% (21 of 26).

Surgical management of ventricular septal defects in infants

Infants with ventricular septal defect (VSD) who are symptomatic despite intensive medical therapy require surgical intervention. Choice of treatment depends upon the cumulative mortality and morbidity rates of the two-stage approach of initial pulmonary artery banding followed by debanding and VSD closure as compared to the risk of primary intracardiac repair in infancy. Sixteen infants underwent pulmonary artery banding at Columbia-Presbyterian Medical Center between 1967 and 1976, with one operative death but with a significant incidence of morbidity and late death. Forty patients underwent pulmonary artery debanding and closure of VSD with three operative deaths. This second-stage procedure was frequently complicated by repair of acquired lesions. During the same 10 year period 37 infants underwent primary closure of VSD with eight operative deaths. The morbidity related to this procedure is low. With the use of profound hypothermia and circulatory arrest, results have significantly improved and the risk of early correction now compares favorably with the cumulative mortality rate of the two-stage approach. Primary intracardiac repair is the procedure of choice.

Open heart correction of the ventricular septal defect in infants : K. Satoh, S. Tanaka, Y. Suzuki, T. Itoh, E. Ishizawa, T. Horiuchi, M. Yoshinari, and S. Matsukawa. J Jap Soc Pediatr Surg 13:435–442 (April), 1977

Open heart correction of the ventricular septal defect in infants : K. Satoh, S. Tanaka, Y. Suzuki, T. Itoh, E. Ishizawa, T. Horiuchi, M. Yoshinari, and S. Matsukawa. J Jap Soc Pediatr Surg 13:435–442 (April), 1977

Correction of Type B interrupted aortic arch with ventricular septal defect in infancy

The successful correction of a Type B interrupted aortic arch (IAA) with simultaneous closure of a ventricular septal defect (VSD) in a 6-month-old infant is described. With the use of profound hypothermia and limited cardiopulmonary bypass, a flap of pulmonary artery, together with the persistent ductus arteriosus (PDA), was dissected free and sutured so as to form a tube which then was anastomosed to the ascending aorta. The ventricular septal defect and the pulmonary arteriotomy then were closed. Cardiac catheterization 5 months later demonstrated a satisfactory reconstruction with no gradient between the ascending and descending aorta.

Early and Late Results of Closure of Ventricular Septal Defect in Infancy

Fifty infants ranging in age from 13 days to 18 months (mean age 6 months) and weighing from 1.7 to 8.2 kg (mean weight 4.5 kg) underwent patch closure of a ventricular septal defect (VSD) with use of deep hypothermic circulatory arrest. Seventeen infants were under 3 months of age. The principal indication for operation was intractable chronic congestive heart failure. All infants were below the third percentile for weight preoperatively. Three patients (6%) died postoperatively within the second month of life. There was no late mortality. Seven infants (14%) had seizures; these were associated with a low output state in 2 infants, with hypoxic episodes in 4 infants, and occurred postoperatively in 1 infant. Postoperatively, 8 (17%) of the surviving infants developed right bundle-branch block and left anterior hemiblock, and 16 (32%) developed right bundle-branch block alone. One year postoperatively, catheterization studies in 24 children revealed normal pulmonary artery pressure and pulmonary vascular resistance in all; there were no significant residual ventricular septal defects. Because of these results we continue to be enthusiastic about primary closure of VSD irrespective of age or weight.

単純低体温・冠灌流蘇生法による 2 才未満重症心室中隔欠損症の根治手術 : 術中, 術後の経過を中心に

単純低体温・冠灌流蘇生法による 2 才未満重症心室中隔欠損症の根治手術 : 術中, 術後の経過を中心に

Late results of surgical closure of large ventricular septal defects in infancy

Late results of surgical closure of large ventricular septal defects in infancy

Presentation of atrial septal defect in infancy

Presentation of atrial septal defect in infancy

Presentation of Atrial Septal Defect in Infancy

Four patients with atrial septal defects and congestive heart failure in the first year of life had none of the classic auscultatory findings of atrial septal defect. Three of four had murmurs suggestive of innocent pulmonary-artery branch stenosis.

Corrective treatment of isolated ventricular septal defect in infancy

Intracardiac correction of VSD in infants should be indicated if the mortality and morbidity of the operation at this age group is lower than cumulative mortality of pulmonary artery banding plus second-staged procedure mortality. Experience with closure of VSD in 23 patients under 1 yr of age with 4% mortality and low morbidity is presented. Indications for operation are: (1) intractable heart failure; (2) persistence or progression of pulmonary hypertension; and (3) failure of banding procedure. Deep hypothermia and circulatory arrest facilitated the intracardiac repair in all patients. Mortality and morbidity related to the banding procedure are emphasized, and it is suggested that banding be restricted only to patients with associated coarctation of the aorta or to patients with multiple muscular ventricular septal defects in whom left ventriculotomy can be safely performed at an older age.

Quantitative structural analysis of pulmonary vessels in isolated ventricular septal defect in infancy.

Structural changes in the pulmonary circulation were studied in the lungs of 5 infants dying with ventricular septal defect. Applying precise quantitative morphological techniques to the pulmonary vessels, it was possible to correlate pathological change with clinical and haemodynamic findings, and to identify two patterns of response. Three of the infants (group I) ppresnted in cardiac failure with a large pulmonary blood flow, dilated and tortuous pulmonary arteries, and fewer intra-acinar vessels than normal. Medial hypertrophy was moderate and affected chiefly the larger arteries, i.e. those with a diameter greater than 200 mum. The other 2 infants (group 2) had a high pulmonary vascular resistance with an intermittent right-to-left shunt. The pulmonary arteries were of normal size and the reduction in the number of the arteries was less striking. Medial hypertrophy was greater than in the first group and affected all sizes of artery including those less than 200 mum in diameter. In both groups, muscle extended further along the axial pathway. Muscular hypertrophy was found also in the vein wall in most cases and, as with the arteries, was more severe in those with a higher pulmonary vascular resistance. The findings illustrate the variation in pulmonary vascular response in infants with a ventricular septal defect. It is suggested that in patients with a ventricular septal defect, arterial muscularity usually regresses after birth and a left-to-right shunt develops; secondary hypertrophy of the media then develops in reaponse to the shunt. Our findings also suggest, however, that in some infants arterial muscle fails to regress postnatally so that pulmonary blood flow is never high and a right-to-left shunt develops soon after birth.

Observation on the adequancy of cardiopulmonary bypass combined with moderate hypothemia for surgical closure of ventricular septal defect in infancy

Observation on the adequancy of cardiopulmonary bypass combined with moderate hypothemia for surgical closure of ventricular septal defect in infancy

Clinicopathologic correlations. Atrial septal defect in infancy: common association with other anomalies.

The atrial septum was evaluated in necropsy specimens from subjects who died under the age of one year. Observations indicated that when an atrial septal defect (ASD) was present, there was commonly an associated condition. In the vast majority, the ASD was at the fossa ovalis and took the form of valvular incompetent foramen ovale. The findings strongly support the concept that an ASD at the fossa ovalis found in symptomatic infants is acquired secondary to the effects of an underlying anomaly. Overloading of the left or right atrium appears to be the mechanism resulting in the formation of an acquired ASD. In infants with various anomalies that cause overloading of the left atrium, such as left-to-right shunts from ventricular septal defect and left-sided inflow obstruction, the incidence of a defect at the fossa ovalis was 18% and 29%, respectively. A similar type of ASD was found in 31% of the cases with right-sided inflow or outflow obstruction.

Symptomatic atrial septal defect in infants

Clinical and hemodynamic data obtained in seven infants with atrial septal defects who developed congestive heart failure and recurrent pneumonia during the first year of life were analyzed. Auscultatory findings were variable and were not specific for atrial septal defect. Vigorous medical management was sufficient to maintain these infants during the critical first year of life. Because of the good prognosis it is imperative to differentiate this defect from other cardiac lesions which cause large left-to-right shunts and which require early surgical intervention.

Symptomatic atrial septal defect in infancy.

Atrial septal defect of the ostium secundum variety (ASD) is uncommonly diagnosed in infancy and rarely results in congestive heart failure (CHF). Eleven patients with uncomplicated ASD who developed CHF between 6 days and 13 months of age are presented. The diagnosis of ASD was documented by cardiac catheterization in all 11 patients. Left-to-right shunt ranged from 52 to 80%. Right ventricular pressure was near systemic levels in two patients and at least somewhat elevated in the other nine. Total pulmonary resistance (TPR) was within normal limits in all 11. No left ventricular obstructive lesions were found. Although one patient had unusual thickening of the left ventricular myocardium, and the left ventricular cavity was enlarged in two other cases, no specific abnormality in left or right ventricular function could be defined. Spontaneous closure of the ASD did not occur in any of our patients. Since spontaneous closure even of a large ASD can occur, however, it seems advisable to defer elective surgical closure until after 2 years of age if successful medical management can be achieved. In those patients in whom early surgery is not necessary, the clinical course usually becomes that of a typical ASD by age 2 years.

Open-heart repair of ventricular septal defect in infancy by means of surface-induced hypothermia and coronary perfusion.

This is a follow-up study of the second consecutive series of 71 infants during the year of 1965 through 1970. Over-all mortality rate was 15.5 per cent. In the last two years, the result has improved markedly as exemplified by only one death occuring in 33 patients (3 per cent) operated. The striking decrease in the mortality rate during this period was mainly due to the intensive care of postoperative respiratory dysfunction and prevention of low cardiac output especially in infants under one year of age. Permanent heart block and complications of the central nervous system have not been observed in this series. In conclusion, patients with VSD and pulmonary hypertension should be advised to undergo radical operation even in early stage of infancy.