The Early “Unnatural” History Following Surgical Repair of Ventricular Septal Defects

  • Sathish M. Chikkabyrappa
  • Justin T. Tretter
  • Arpan R. Doshi
  • Sujatha Buddhe
  • Puneet Bhatla
  • Achi Ludomirsky
Keywords: ventricular heart septal defect, congenital heart defect, mitral regurgitation, dilations, pediatrics

Abstract

Introduction

Surgical outcomes for simple ventricular septal
defects (VSD) have been excellent in the past three decades. For
this project, the timing of resolution of left-sided dilation and mitral
regurgitation (MR) following VSD repair was assessed.

Methods

Echocardiographic data surrounding surgery of 42 consecutive
children who underwent surgical patch repair of a VSD were
reviewed. The echocardiograms were reviewed up to a mean of 12
months post-operatively (range 9 - 14 months). Quantitative data
indexed to body surface area including left atrial (LA) volume, mitral
valve annulus diameter, and left ventricular end-diastolic dimension
(LVEDD) was analyzed.

Results

The majority of our pre-surgical cohort had only trace
(44%) or no MR (31%), with a small proportion having mild (16%)
or moderate MR (9%). No patients had moderate or greater MR following
repair at follow-up. The median mitral valve annular Z-score
was 1.8 (SD 1.6; range: -1.2 to 4.1) pre-operatively, improving to a 0.6
(range: -1.7 to 2.4; p < 0.001) at follow-up. LA dilation was present in
70% of patients, with a median LA volume Z-score of 1.1 (range: -2.6
to 15.5), decreasing to 13% median Z-score -1.2 (range: -3.5 to 2.9; p
< 0.001) at follow-up. LV dilation was present in 81% of pre-operative
patients with a median LVEDD Z-score of 3.0 (range: -2.0 to 7.9).
There was significant improvement in qualitative assessment of LV
enlargement (25%) with a median LVEDD Z-score of 0.5 (range:
-2.1 to 2.9; p < 0.001) at follow-up. Discharge echocardiogram was
performed at a mean of 5.7 days (range: 3 - 12 days) following surgery.

Conclusions

Normalization of LA, mitral valve annulus, and LV size
occurred within the first three months in the majority of patients, with
significant changes occurring within the first post-operative week
following surgical repair for VSD.

Published
2019-11-26
Section
Original Research