Article Sidebar

PDF
Date Published: 14/10/2021
Abstract Views: 898
Views PDF: 597
DOI: https://doi.org/10.47972/vjcts.v34i.614
Issue
Vol. 34
Section
Research Article
How to Cite
Thao, D. P., Chang, V. T., Tien, D. A., & Thuy, N. T. (2021). Surgical results for closure of ventricular septal defect with severe pulmonary hypertension in children at Cardiovascular Center - E hospital. The Vietnam Journal of Cardiovascular and Thoracic Surgery, 34, 30-42. https://doi.org/10.47972/vjcts.v34i.614

Surgical results for closure of ventricular septal defect with severe pulmonary hypertension in children at Cardiovascular Center - E hospital

Dinh Phuong Thao, Vu Thi Chang, Do Anh Tien, Nguyen Tran Thuy

Main Article Content

Abstract

Objectives: To describe the characteristics of clinical manifestations, laboratory and evaluation early treatment results and after 3 months in children who underwent surgery for Ventricular septal defect (VSD) closed - severe pulmonary hypertension (PH) at Cardiovascular Center – E Hospital.


Subjects   and   Methods: A prospective and retrospective descriptive study on 60 patients diagnosed with VSD – severe pulmonary hypertension at Cardiovascular Center – E Hospital from 8/2018 to 3/2021.


Results: 60 patients in the study, 59 patients underwent surgery, the mean age was 8.98 months, the average weight was 5.49 kg. 57 patients (95.0%) grade II-III heart failure before surgery, 43 patients (71.7%) with moderate to severe malnutrition. The mean preoperative pulmonary artery pressure (PAP) was 71.53 ± 9.42 mmHg (60 – 90 mmHg). Average size of VSD was 9.23 ± 3.32 (6 - 20mm). Cardiopulmonary bypass/ the aortic cross-clamp times was 67,8 ± 24,5/ 44,3 ± 20,4 minutes. There was 1 early deaths (1,7%), 14 (23,7%) with residual shunt, 15 patients (25.4%) with right bundle branch block, 1 patient (1.7%) AV block III requires a pacemaker. PAP after surgery was 30.81 ± 11.01 (15 - 70 mmHg).


Follow-up after surgery for an average of 3 months: there was no late death, PAP at follow-up was 22.36 ± 7.83 (15 - 50 mmHg). The group of children operated before 12 months, the percentage of patients PAP value returned to normal higher than the group of children operated after 12 months (89.6% vs 50.0%), statistical  significance at  p < 0,05. There were 53 patients with heart failure grade I (94, 6%) and 41 patients (73.2%) had normal weight for age at the time of re-examination.


Conclusion: The surgery VSD closed is the most thorough and optimal treatment method for VSD with severe PH. Our study showed a good outcome after surgery, the success rate was 98.3%, the frequency of complications was low and all were detected and treated promptly. In the group of children operated before 12 months, the percentage of patients PAP value returned to normal higher than the group of children operated after 12 months.

Article Details

Keywords

Ventricular septal defect, severe pulmonary hypertension, outcomes after congenital heart surgery, 60 children, Cardiovascular Center - E hospital

References

1. Nguyễn Quang Minh (2019), Đặc điểm lâm sàng, cận lâm sàng và đánh giá kết quả điều trị phẫu thuật vá thông liên thất ở trẻ có cân nặng ≤ 5kg tại trung tâm tim mạch bệnh viện E, Luận văn Thạc sĩ Y học, Đại học Y Hà Nội.
2. Tăng Hùng Sang và Vũ Minh Phúc (2010), "Đặc điểm của trẻ thông liên thất được phẫu thuật tại Bệnh viện Nhi đồng 1", Tạp chí Y học Thành phố Hồ Chí Minh. 1.
3. Lê Minh Sơn (2007), Nghiên cứu đặc điểm lâm sàng, cận lâm sàng và kết quả điêu trị thông liên thất có tăng áp lực động mạch phổi nặng ở trẻ em tại Bệnh viên Việt Đức, Luận văn Thạc sĩ Y học, Đại học Y Hà Nội.
4. Ngọ Văn Thanh, Nguyễn Lân Hiếu và Nguyễn Văn Mão (2010), "Tăng áp phổi trong bệnh lý tim bẩm sinh trẻ em", Bệnh viện Tim Hà Nội, Viện Tim mạch Việt Nam.
5. Đào Hữu Trung và Phạm Nguyễn Vinh (Thông Liên Thất), Bệnh học tim mạch, Nhà xuất bản Y học Hà Nội.
6. Aydemir N. A, Karaci A. R , Harmandar B and et al (2013), "Results for surgical closure of isolated ventricular septal defects in patients under one year of age", Journal of Cardiac Surgery: Including Mechanical and Biological Support for the Heart and Lungs. 28(2), pp. 174-179.
7. Andersen H, Tsang V. T , Leval D and et al (2006), "Is complete heart block after surgical closure of ventricular septum defects still an issue?", The Annals of thoracic surgery. 82(3), pp. 948-956.
8. Anderson B. R, Nicolson S. C , Stevens K. N and et al (2013), "Contemporary outcomes of surgical ventricular septal defect closure", The Journal of thoracic and cardiovascular surgery. 145(3), pp. 641-647.
9. Ergun S, Yildiz O , Genc, S. B and et al (2019), "Risk factors for major adverse events after surgical closure of ventricular septal defect in patients less than 1 year of age: a single-center retrospective", Brazilian journal of cardiovascular surgery. 34, pp. 335-343.
10. Fraser III C. D, Thibault D, Ravekes W và and al (2021), "Diaphragm paralysis after pediatric cardiac surgery: An STS Congenital Heart Surgery Database study", The Annals of Thoracic Surgery. 112(1), pp. 139-146.
11. Ikawa S, Nakano S, Shimazaki Y and et al (1995), "Pulmonary vascular resistance during exercise late after repair of large ventricular septal defects: Relation to age at the time of repair", The Journal of thoracic and cardiovascular surgery. 109(6), pp. 1218-1224.
12. Jortveit J, Eskedal L , Leirgul E and et al (2016), "Mortality and complications in 3495 children with isolated ventricular septal defects", Archives of disease in childhood. 101(9), pp. 808-813.
13. Kogon B, Butler H, Kirshbom P and et al (2008), "Closure of symptomatic ventricular septal defects: how early is too early?", Pediatric cardiology. 29(1), pp. 36-39.
14. Karadeniz C, Demir F , Atalay S and et al (2015), "Does surgically induced right bundle branch block really effect ventricular function in children after ventricular septal defect closure?", Pediatric cardiology. 36(3), pp. 481-488.
15. Kirklin J. W and Barratt B.G (2003), "Ventricular septal defect", Cardiac Surgery, pp. 1262.
16. Pedersen T. A, Knudsen M. R , Andersen N. H và and al (2008), "The effects of surgically induced right bundle branch block on left ventricular function after closure of the ventricular septal defect", Cardiology in the Young. 18(4), pp. 430-436.
17. Scully B. B, Zafar F, David L. S and et al (2010), "Current expectations for surgical repair of isolated ventricular septal defects", The Annals of thoracic surgery. 89(2), pp. 544-551.
18. Siehr S. L, Reddy, V. M ,Hanley F. L and et al (2014), "Incidence and risk factors of complete atrioventricular block after operative ventricular septal defect repair", Congenital heart disease. 9(3), pp. 211-215.
19. Schipper M, Slieker M. G , Schoof P. H and et al (2017), "Surgical repair of ventricular septal defect; contemporary results and risk factors for a complicated course", Pediatric cardiology. 38(2), pp. 264-270.
20. Vaidyanathan B, Rao S. G , Roth S. J and et al (2002), "Outcome of ventricular septal defect repair in a developing country", The Journal of pediatrics. 140(6), pp. 736-741.
21. Zhang J, Guileyardo J. M, Ko J. M and et al (2015), A review of spontaneous closure of ventricular septal defect, Baylor University Medical Center Proceedings, Taylor & Francis, pp. 516-520.