Long-term outcome of patients operated for large ventricular septal defects with increased pulmonary vascular resistance

  • Kannan B
  • Sivasankaran S
  • Tharakan J
 et al. 
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Abstract

BACKGROUND: There is a paucity of data regarding the long-term outcome of patients operated for ventricular septal defect with severe pulmonary arterial hypertension and elevated pulmonary vascular resistance. METHODS AND RESULTS: We evaluated the long-term follow-up results of a selected cohort of patients with nonrestrictive ventricular septal defect and elevated pulmonary vascular resistance (>6 Wood units). Thirty-eight patients, median age 7.5 years (range 6 months-27 years), with nonrestrictive ventricular septal defect with severe pulmonary hypertension were operated between 1985 and 1996 at our institute. Preoperative pulmonary vascular resistance, ratio of pulmonary blood flow to systemic blood flow, and ratio of pulmonary vascular resistance to systemic vascular resistance were 7.63+/-1.8 Wood units, 1.9+/-0.48, and 0.41+/-0.12, respectively. The majority (68.4%) had perimembranous ventricular septal defect. Thirty patients (79%) had a good outcome and were asymptomatic at a mean follow-up of 8.7 years, with significant reduction in pulmonary artery pressures. Eight patients (21%) had a poor outcome, which included 5 immediate postoperative deaths, 1 late death and 2 surviving patients with persistent severe pulmonary arterial hypertension. There was no significant difference regarding hemodynamic parameters at baseline between those who had a good outcome and those who did not. Eleven patients with a preoperative pulmonary blood flow to systemic blood flow ratio of

Author-supplied keywords

  • *Cardiopulmonary Bypass/mortality
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Heart Septal Defects, Ventricular/mortality/*physi
  • Hemodynamics/physiology
  • Humans
  • Hypertension, Pulmonary/mortality/*physiopathology
  • India
  • Infant
  • Male
  • Retrospective Studies
  • Time
  • Treatment Outcome
  • Vascular Resistance/*physiology

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Authors

  • B R Kannan

  • S Sivasankaran

  • J A Tharakan

  • T Titus

  • V K Ajith Kumar

  • B Francis

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