Septal Defect In Infants Research Articles

Magnetic resonance imaging at a high field strength of ventricular septal defects in infants.

Magnetic resonance imaging at a high field strength has potential benefits for the study of the heart in infants, which is when most congenital heart disease presents. Seventeen infants with various anatomical types of ventricular septal defect were studied by this technique. Good quality, high resolution, images were obtained in every case. There were no major practical problems. The morphology of the defects in all 17 hearts was displayed in great detail. In some instances, the interpretation of the images resembled that of equivalent images from cross sectional echocardiography. But this new technique allowed imaging in planes that cannot be obtained by echocardiography. One particularly valuable plane gave a face on view of the inlet and trabecular components of the septum. This allowed very precise localisation of defects in these areas. The relation between the defects and the atrioventricular and arterial valves was exceptionally well shown in various different imaging planes. One patient in the series had multiple trabecular defects that were clearly shown. Magnetic resonance imaging gives detailed morphological information about ventricular septal defects.

Repair of large muscular ventricular septal defects in infants employing left ventriculotomy

The approach to muscular ventricular septal defect has been controversial. Traditional approaches have included pulmonary artery banding or right ventriculotomy. Left vcntriculotomy has been employed in older children because of the ease of exposure in the absence of trabeculations, but concern has been raised regarding potential loss of left ventricular function. Four infants less than 4 months of age underwent repair of a large muscular ventricular septal defect by left ventriculotomy. One infant had no associated defects; 2 had undergone previous coarctation repair (1 with pulmonary artery banding); and 1 had a large secundum atrial septal defect. All had congestive heart failure refractory to maximal medical management. All patients survived, and there was no myocardial dysfunction. Echocardiographic indices of ventricular function 3 to 24 months postoperatively were normal (mean shortening fraction, 32.5%). Left ventriculotomy with patch closure of the ventricular septal defect provides a simple approach to a large muscular ventricular septal defect in infants with heart failure.

Twenty-five-year experience with ventricular septal defect in infants and children

Three hundred eighty-one children with isolated VSD were catheterized from 1960 through 1985, 228 of whom were first catheterized in the first year of life. Defect size was defined by the right-to-left ventricular systolic pressure ratio. Patients with small VSD had a good outcome, with no pulmonary vascular disease. Seventy-five percent of patients with moderate VSDs did not require surgery, and 58% had normal pulmonary artery pressures documented on a second catheterization. Of those patients with large VSDs who underwent serial catheterizations in the first year of life before surgery, 62% had partial closure, and pulmonary vascular resistance rose in 21%. None developed pulmonary vascular disease after surgery. Fewer large-restrictive than nonrestrictive VSDs required surgery in infancy (12% vs 51%; p < 0.005), and more closed enough to never require surgery (62% vs 27%; p < 0.005, chi square). Surgery is rarely necessary for patients with small and moderatesized VSDs in the first year and is usually never necessary because of the expected decrease in size. Few patients with large-restrictive VSDs have an increase in pulmonary vascular resistance, many defects decrease in size, and most patients never need surgery. Patients who have a nonrestrictive VSD have an excellent prognosis with appropriate management.

The repair of atrioventricular septal defects in infancy

Two (3%) of 72 patients undergoing repair of atrioventricular septal defects, 1984–September 1985, died in hospital, and among the 58 patients with isolated atrioventricular septal defect, one (2%) died in hospital. One (3%) of the 30 patients with isolated atrioventricular septal defects undergoing repair in the first year of life died. The absence of an incremental risk of young age is a continuation of the trend demonstrated in a parametric analysis of the earlier 1967–1982 experience ( n = 310). The hospital mortalities were similar in 1984–September 1985 after repair of partial and complete atrioventricular septal defects, again a continuation of the earlier trend as is the lessened hospital mortality (7%) in the current era among patients with major associated cardiac anomalies. The continuity of results in the two eras, and the predictability of the results in the current era from equations developed from the earlier one, give a high degree of confidence in the inference that primary repair in the first year of life is advisable for most patients with atrioventricular septal defects. Ten-year survival of such patients operated upon currently is predicted to be 99 and 95% for partial and complete atrioventricular septal defects, respectively.

Closure of ventricular septal defect in infancy.

Journal of Cardiac SurgeryVolume 1, Issue 2 p. 135-150 Closure of Ventricular Septal Defect in Infancy JAROSLAV STARK F.R.C.S., F.A.C.S., Corresponding Author JAROSLAV STARK F.R.C.S., F.A.C.S. The Hospital for Sick Children, London, EnglandConsultant Cardiothoracic Surgeon, The Hospital for Sick Children, Great Ormond Street, London WC1N 3JH, England.Search for more papers by this authorBABILAL SETHIA F.R.C.S., BABILAL SETHIA F.R.C.S. The Hospital for Sick Children, London, EnglandSearch for more papers by this author JAROSLAV STARK F.R.C.S., F.A.C.S., Corresponding Author JAROSLAV STARK F.R.C.S., F.A.C.S. The Hospital for Sick Children, London, EnglandConsultant Cardiothoracic Surgeon, The Hospital for Sick Children, Great Ormond Street, London WC1N 3JH, England.Search for more papers by this authorBABILAL SETHIA F.R.C.S., BABILAL SETHIA F.R.C.S. The Hospital for Sick Children, London, EnglandSearch for more papers by this author First published: June 1986 https://doi.org/10.1111/j.1540-8191.1986.tb00703.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume1, Issue2June 1986Pages 135-150 RelatedInformation

Repair of atrioventricular septal defects in infancy

Fifteen infants less than 12 months of age with complete atrioventricular septal defects underwent repair of the defect between January, 1981, and December, 1984. The average age at operation was 8 1/2 months and the average weight was 5.7 kg. Eight of 15 (53%) infants had preoperative mild to moderate mitral insufficiency. Pulmonary artery hypertension was present in all infants and 13 of 15 infants had a pulmonary arterial resistance greater than 4 units (mean 8.8 units). Operative indication was based on pulmonary artery hypertension, congestive heart failure, and failure to thrive. Ventricular distention was utilized during operative repair to assess location of valve incision, level of attachment of valves to the patch, and cleft approximation. It was also used to check the competency of the mitral repair once complete. The average circulatory arrest time was 55.7 minutes. There were no operative deaths. There were two late deaths. We conclude that ventricular distention is the key to the operation, and operative repair is safe in infants with atrioventricular septal defects.

Spontaneous closure of isolated secundum atrial septal defects in infants: An echocardiographic study

The incidence and timing of spontaneous closure of isolated secundum atrial septal defects are unknown. Twenty-nine consecutive infants under 12 months of age with clinical evidence of significant left-to-right shunting through atrial septal defects were evaluated by M-mode and two-dimensional echocardiography (2DE). All had right ventricular hypertrophy by ECG. Right ventricular, right atrial, and left atrial areas were measured and right ventricular and left atrial dimensions were obtained in all patients. Spontaneous closure of the defect in four infants was suggested by normalization of clinical examination and ECG and was documented by 2DE and M-mode echocardiography at 15 to 31 months of age. All of the remaining patients, who had suitable 2DE echocardiograms and who did not spontaneously close their defects, had enlarged right ventricular and right atrial areas. Left atrial areas were normal in the four who closed spontaneously and were large in all but three who did not close. The mean diameter of the defect was similar for all patients. The 14% incidence reported here may underestimate the true incidence of spontaneous closure, since seven patients had surgical closure, all prior to 30 months of age, the oldest age at which spontaneous closure was documented. An atrial septal flap, found in all four patients who closed spontaneously but only in 4 of the 16 patients who did not close spontaneously, may contribute in some way to spontaneous closure. Since spontaneous closure may occur up to 30 months, it seems clear that surgical closure should not be performed before that age unless medical management has failed to control symptoms.

Deep Hypothermia with Reduced Flow Rates for Correction of Ventricular Septal Defects in Infants. An Alternative Approach

In this presentation our experience of the correction of large ventricular septal defects (VSD) under deep hypothermia (DH) and reduced flow rates in infants is reported. Sixty patients with VSD and pulmonary hypertension were operated. The age of the patients varied from 1.5 to 12 months and body weight from 3.0 to 8.7 kg. Deep hypothermia was achieved by cooling the patient using a heart-lung machine after aortic and right atrial cannulation. At a rectal temperature of 18 degrees C, pump flow was reduced to 0.28 l . min-1 . m-2 and cardiotomy was performed. Venous blood from the right atrium was aspirated with a single coronary sucker. The aorta was not clamped. After completion of the intracardiac repair, pump flow was increased and the patient was rewarmed to a rectal temperature of 36 degrees C. In all cases cardiac rhythm was restored spontaneously during rewarming. In every patients, the VSD was closed with a xenopericardial patch (in 42 patients from a right atrial approach and in 18 patients through the ventriculotomy). In 5 patients a patent ductus was also ligated and in 37 patients an atrial septal defect was sutured. The hospital mortality was 5% (3 patients). In the remaining 57 patients the cardiac index during the first 48 hours after operation was 2.5-4.2 l . min-1 . m-2. Patients were extubated between 18 and 44 hours after the operation. Deep hypothermia with reduced flow rates during intracardiac repair provides excellent myocardial protection and exposition in infants with VSD.

乳児期重症心室中隔欠損症に対する開心根治手術

乳児期重症心室中隔欠損症に対する開心根治手術

Combined discrete subaortic stenosis and ventricular septal defect in infants and children

Eight patients, aged 1 to 8 years, with discrete subaortic stenosis (DSS) and ventricular septal defect (VSD) were studied by 2-dimensional (2-D) and M-mode echocardiography. Initial cardiac catheterization and angiocardiography showed VSD and other associated cardiac lesions, including coarctation of the aorta and patent ductus arteriosus. None had evidence of DSS. Six patients underwent surgical repair of the associated lesions, but none required closure of the VSD. Ultimately, 6 patients had spontaneous closure of VSD, and 2 had a residual small VSD. Subsequent serial echocardiography showed evidence of subaortic membrane, prompting repeat cardiac catheterization, which confirmed moderate to severe peak systolic pressure gradients between the left ventricle and ascending aorta. Surgical resection of the membrane was performed in 5 patients. Thus, in patients with small or spontaneously closed VSDs, DSS may develop. Evaluation of the left ventricular outflow tract area is recommended in patients with small or closed VSD in whom a significant heart murmur or electrocardiographic abnormality remains.

Spontaneous closure of secundum atrial septal defect in infants and young children

The records of 264 pediatric patients with uncomplicated ostium secundum atrial septal defect (ASD) were reviewed. Eighty-seven patients were younger than age 4 years at the time of cardiac catheterization. Subnormal weight gain, frequent pneumonia, cyanosis or tachypnea were present in 26 patients (30%). Of the 36 infants at catheterization, 17 (48%) had the previously described symptoms, including 12 (33%) who had congestive heart failure. Eight of the 36 infants were found to have closed their defect at a subsequent catheterization. Six of 18 patients who underwent cardiac catheterization between 1 and 2 years of age also had spontaneously closed their ASD at subsequent study. Statistical analysis of hemodynamic data revealed no difference (except a smaller shunt size) between ASDs that closed and those that did not in patients who were <4 years at initial catheterization. Analysis of hemodynamic data revealed no statistical differences between groups of patients with an ASD who were younger than and those older than 4 years at time of diagnostic study. Patients with ASDs that closed were significantly different from patients with atrial level shunting thought to be secondary to a valve-incompetent foramen ovale with respect to age at initial study (11 versus 2 months, p <0.001), mean left atrial pressure (7.7 versus 12.3 mm Hg, p <0.02) and difference between mean right and left atrial pressures (1.0 versus 4.2 mm Hg, p <0.01). Because of this high incidence of spontaneous closure of ASD, even in symptomatic patients, intensive medical management rather than surgical correction is recommended for patients with ASD who are younger than age 2 years. Elective surgical repair of ASD diagnosed after age 4 years is recommended because spontaneous closure after that age is probably unlikely.

Transposition of the Great Arteries and Ventricular Septal Defect: Results with the Senning Operation and Closure of the Ventricular Septal Defect in Infants

From May, 1978, to July, 1982, 46 infants ranging in age from 12 days to 12 months and in weight from 2.1 to 8.4 kg underwent repair of dextrotransposition of the great arteries ( d-TGA) and ventricular septal defect (VSD) using a Senning repair and closure of the VSD. Ventricular septal defects were classified as membranous (47.8%), maialigned (28.3%), atrioventricular (AV) canal type (13.0%), subarterial (2.2%), muscular (2.2%), and multiple (6.5%). Hospital mortality was 15.2% and late mortality, 5.1%. Postoperative complications included tricuspid regurgitation (mild in 3 and severe, requiring tricuspid valve replacement, in 3), residual VSD (pulmonary/systemic flow ratio of greater than 2:1) in 3 patients (2, AV canal type and 1, multiple VSDs), pulmonary venous obstruction in 3 patients, and permanent complete heart block in 4 patients (2, AV canal type of VSD also requiring tricuspid valve replacement). Lung biopsy studies showed reversible Heath-Edwards and morphometric changes. No patient was seen with Heath-Edwards III or greater changes. In 10 patients, right ventricular end-diastolic pressures and pulmonary artery pressures at rest were within normal limits one year after operation. As the operative mortality of atrial inversion and arterial switch operations for d-TGA with VSD tends to become comparable, more extensive follow-up data, including cardiac catheterization and coronary arteriography in a large number of patients, will be necessary to establish the superiority of one approach over the other.

Ventricular septal defect in infancy. Surgical criteria and experience.

The optimal surgical management of ventricular septal defects (SVD) in infancy and particularly in small babies, still remains controversial. Seventy-six infants with VSD as the major cardiac lesion were operated upon from March 1978 to December 1981. Forty-three underwent primary repair with a 9.3% mortality rate. Pulmonary artery banding (PAB) was performed in 33 infants without mortality. Sixteen of them had subsequent debanding and VSD closure, also without mortality. Based on our own experience, our current recommendations are as follows: PAB in severely ill infants under 3 months of age, in infants with multiple or "Swiss-cheese type VSD" and in some cases of VSD with associated anomalies. Early debanding and correction, except in cases with multiple VSDs. Primary repair in infants aged more than 3 months and in some selected younger cases, according to the anatomical location of the defect.

Angiocardiography of multiple ventricular septal defects in infancy.

HomeCirculationVol. 66, No. 5Angiocardiography of multiple ventricular septal defects in infancy. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAngiocardiography of multiple ventricular septal defects in infancy. K E Fellows, G R Westerman and J F Keane K E FellowsK E Fellows Search for more papers by this author , G R WestermanG R Westerman Search for more papers by this author and J F KeaneJ F Keane Search for more papers by this author Originally published1 Nov 1982https://doi.org/10.1161/01.CIR.66.5.1094Circulation. 1982;66:1094–1099 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Van Praagh R (2022) Ventricular Septal Defects Congenital Heart Disease, 10.1016/B978-1-56053-368-9.00016-0, (767-817), . Kitagawa T, Kitaichi T, Sugano M and Kurobe H (2013) Techniques and results in the management of multiple muscular trabecular ventricular septal defects, General Thoracic and Cardiovascular Surgery, 10.1007/s11748-013-0267-8, 61:7, (367-375), Online publication date: 1-Jul-2013. Perloff J and Marelli A (2012) Ventricular Septal Defect Clinical Recognition of Congenital Heart Disease, 10.1016/B978-1-4377-1618-4.00017-1, (283-315), . Hernández-González M, Espínola-Zavaleta N, Solorio S, Malacara-Hernández J, Jarquin V, Díaz de León V and López-Valenzuela P (2007) Resonancia magnética cardiovascular en la cuantificación de los cortocircuitos de izquierda a derecha en los defectos septales cardiacos con hipertensión arterial pulmonar, Revista Española de Cardiología, 10.1157/13109643, 60:9, (907-913), Online publication date: 1-Sep-2007. Baden W and Schmaltz A (1998) Anomalien des linken Ventrikels und der Aorta Pädiatrische Kardiologie, 10.1007/978-3-642-53754-7_4, (169-212), . Magee A, Boutin C, McCrindle B and Smallhorn J (1998) Echocardiography and cardiac catheterization in the preoperative assessment of ventricular septal defect in infancy, American Heart Journal, 10.1016/S0002-8703(98)70053-5, 135:5, (907-913), Online publication date: 1-May-1998. Ramaciotti C, Vetter J, Bornemeier R and Chin A (1995) Prevalence, relation to spontaneous closure, and association of muscular ventricular septal defects with other cardiac defects, The American Journal of Cardiology, 10.1016/S0002-9149(99)80529-3, 75:1, (61-65), Online publication date: 1-Jan-1995. Mehta A and Chidambaram B (1992) Ventricular septal defect in the first year of life, The American Journal of Cardiology, 10.1016/0002-9149(92)90620-E, 70:3, (364-366), Online publication date: 1-Aug-1992. Serraf A, Lacour-Gayet F, Bruniaux J, Ouaknine R, Losay J, Petit J, Binet J, Planché C and Kirklin J (1992) Surgical management of isolated multiple ventricular septal defects, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/S0022-5223(19)34982-7, 103:3, (437-443), Online publication date: 1-Mar-1992. Freedom R and Benson L (1992) Ventricular Septal Defect Neonatal Heart Disease, 10.1007/978-1-4471-1814-5_34, (571-591), . Marino B, Corno A, Guccione P and Marcelletti C (1991) Ventricular septal defect and Down's syndrome, The Lancet, 10.1016/0140-6736(91)92218-Q, 337:8735, (245-246), Online publication date: 1-Jan-1991. Chin A, Alboliraas E, Barber G, Murphy J, Helton J, Pigott J and Norwood W (1990) Prospective detection by Doppler color flow imaging of additional defects in infants with a large ventricular septal defect, Journal of the American College of Cardiology, 10.1016/0735-1097(90)92840-X, 15:7, (1637-1642), Online publication date: 1-Jun-1990. Sutherland G, Smyllie J, Ogilvie B and Keeton B (1989) Colour flow imaging in the diagnosis of multiple ventricular septal defects., Heart, 10.1136/hrt.62.1.43, 62:1, (43-49), Online publication date: 1-Jul-1989. Fellows K (1987) Angiography of Congenital Heart Disease Diagnostic and Interventional Catheterization in Congenital Heart Disease, 10.1007/978-1-4613-2333-4_4, (63-90), . Soto B, Cogland C and Bargeron L (1984) Present status of axially angled angiocardiography, Cardiovascular and Interventional Radiology, 10.1007/BF02552817, 7:3-4, (156-165), Online publication date: 1-Jun-1984. November 1, 1982Vol 66, Issue 5 Advertisement Article InformationMetrics Copyright © 1982 by American Heart Associationhttps://doi.org/10.1161/01.CIR.66.5.1094 Originally publishedNovember 1, 1982 PDF download Advertisement

Repair of large ventricular septal defects in infants and small children.

It is possible to achieve excellent results for primary closure of ventricular septal defects regardless of the age of the patients when surgical intervention is required. Thirty-two severely symptomatic patients, age 1-24 months, with large ventricular septal defects (m Qp/Qs = 3.4, m R VSD = 4.0), had primary repair of the defects with one (3%) hospital death. Seven patients (22%) had increased pulmonary vascular resistance ranging from 5.4 to 12 units/m2. It was possible to close the ventricular septal defect through the right atrium in 26 patients (81%). Pulmonary artery banding was not performed in any patient with isolated ventricular septal defect during the period of this study. The 31 survivors have been followed an average of four years, and 30 of them are remarkably improved and remain New York Heart Association Class I or II. Only one patient, with obstructive pulmonary vascular disease (pulmonary resistance = 12 U/m2), died suddenly 16 months after operation. Follow-up catheterization was offered to all patients, and to date, 18 (60%) have been restudied. These hemodynamic data show that pulmonary vascular resistance after surgery is usually normal or only minimally elevated; except for one patient with a large residual ventricular septal defect, functionally significant left to right shunts were eliminated. These results and the analysis of results of combined series reported in the literature for primary and staged operations for the continued practice of primary repair of isolated large ventricular septal defects in infants and children who require surgery.

Study on the Necessity of Early Surgical Closure of a Large Ventricular Septal Defect in Infancy

Study on the Necessity of Early Surgical Closure of a Large Ventricular Septal Defect in Infancy

Transvenous, selective coronary arteriography via ventricular septal defect in infants and children with complex congenital heart disease

Transvenous, selective coronary arteriography via ventricular septal defect in infants and children with complex congenital heart disease

Correction of isolated secundum atrial septal defect in infancy.

Although it is a common congenital cardiac lesion, secundum atrial septal defect (ASD) rarely presents in infancy. Its natural history in the first two decades of life is generally benign. Reports of symptomatic ASD in early childhood stress the place of conservative management, and recommend that the operation should be deferred until school age. Few accounts of the indications for surgery in infancy exist. We present our experience of 6 patients who failed to respond adequately to conservative treatment and required operation for intractable heart failure due to isolated secundum ASD in the first year of life. As their presentation and physical signs were not typical of ASD seen in later childhood, they presented problems both of diagnosis and management.

Ventricular septal defect in infancy: Detection with two dimensional echocardiography

To determine the sensitivity and specificity of two dimensional echocardiography in detecting ventricular septal defect two dimensional echocardiograms were performed on 53 infants under 1 year of age. The diagnosis of ventricular septal defect was confirmed by cardiac catheterization in 27 patients; an intact ventricular septum was confirmed by catheterization in 18 and clinically in 8. Using a 35 ° mechanical sector scanner with a 3.5 megahertz transducer, we imaged the ventricular septum in the long axis and in a four chamber view (apical or subcostal, or both). Images were recorded on videotape and reviewed independently by two observers unaware of the diagnosis. Interobserver agreement was 94 percent. Among the 27 patients with a ventricular septal defect, the lesion was correctly identified in 20 (74 percent) and was undetected in 7 (3 of whom had a defect less than 4 mm in diameter, as determined by angiography). No defect less than 4 mm in diameter was detected. Among the 26 patients with an intact septum, a defect was correctly excluded in 23 (88 percent); a false positive diagnosis was made in 3. The apical and subcostal views demonstrated the greatest number of defects (20 of 20), but also gave the highest number of false positive diagnoses (3 of 3). The long axis view was helpful when positive, but showed only 9 of 20 of the defects. In this study, two dimensional echocardiography detected approximately three fourths of ventricular septal defects large enough to warrant cardiac catheterization in the 1st year of life. False positive diagnoses were related to dropout of echoes in the membranous septum when imaged in the four chamber views.

Trans-pulmonary arterial repair of supracristal ventricular septal defects in infancy

Five patients aged 2 months to 2 years with isolated large supracristal ventricular septal defect (VDS) and severe pulmonary hypertension had corrective operation between April, 1978, and November, 1979, performed via a trans--pulmonary arterial approach. This technique provided excellent exposure for accurate placement of sutures, especially between the two semilunar valves. All patients are well, with no residual defects, and their postoperative electrocardiograms (ECGs) do not show any intraventricular conduction abnormality. The technique is especially useful in the presence of severe pulmonary hypertension, wherein ventriculotomy is best avoided and the dilated main pulmonary artery offers excellent access.