Spontaneous closure of small residual ventricular septal defects after surgical repair

TY - JOUR

T1 - Spontaneous closure of small residual ventricular septal defects after surgical repair

AU - Dodge-Khatami, Ali

AU - Knirsch, Walter

AU - Tomaske, Maren

AU - Prêtre, René

AU - Bettex, Dominique

AU - Rousson, Valentin

AU - Bauersfeld, Urs

PY - 2007/3

Y1 - 2007/3

N2 - BACKGROUND: Residual shunts may be detected by intraoperative or postoperative echocardiography after surgical closure of a ventricular septal defect (VSD). The hemodynamic relevance and rate of late closure are unknown.METHODS: Between 1994 and 2005, 198 consecutive patients underwent surgical correction of an isolated VSD (n = 100), tetralogy of Fallot (n = 52) or atrioventricular septal defect (n = 46). Intraoperative transesophageal echocardiography (TEE) was routine, and postoperative transthoracic echocardiography was performed in the intensive care unit, at hospital discharge, and during follow-up. Residual defects were graded as absent, between 1 and 2 mm, or greater than 2 mm.RESULTS: Shunt-related discrepancy was observed between intraoperative TEE and intensive care unit transthoracic echocardiographic findings; significantly so after Fallot repair (p < 0.0001). After discharge, 83% of all residual defects less than 2 mm closed. Of nine residual defects greater than 2 mm, only three closed after a median follow-up of 3.1 years. In patients with residual shunts, they were hemodynamically insignificant, required no medication, and no endocarditis was noted. At last follow-up, there was no significant difference between the percentage of residual shunts among the three groups (p = 0.135).CONCLUSIONS: Postsurgical residual VSDs less than 2 mm closed spontaneously in the majority within a year. Defects greater than 2 mm are unlikely to close spontaneously. Residual shunts after atrioventricular septal defect repair almost always close, whereas one third will remain open after Fallot or isolated VSD repair. At midterm follow-up, residual shunts remained hemodynamically and clinically irrelevant. Revision of a residual defect greater than 2 mm on cardiopulmonary bypass at initial repair, guided by TEE, may spare late redo surgery and lifelong antibiotic prophylaxis.

AB - BACKGROUND: Residual shunts may be detected by intraoperative or postoperative echocardiography after surgical closure of a ventricular septal defect (VSD). The hemodynamic relevance and rate of late closure are unknown.METHODS: Between 1994 and 2005, 198 consecutive patients underwent surgical correction of an isolated VSD (n = 100), tetralogy of Fallot (n = 52) or atrioventricular septal defect (n = 46). Intraoperative transesophageal echocardiography (TEE) was routine, and postoperative transthoracic echocardiography was performed in the intensive care unit, at hospital discharge, and during follow-up. Residual defects were graded as absent, between 1 and 2 mm, or greater than 2 mm.RESULTS: Shunt-related discrepancy was observed between intraoperative TEE and intensive care unit transthoracic echocardiographic findings; significantly so after Fallot repair (p < 0.0001). After discharge, 83% of all residual defects less than 2 mm closed. Of nine residual defects greater than 2 mm, only three closed after a median follow-up of 3.1 years. In patients with residual shunts, they were hemodynamically insignificant, required no medication, and no endocarditis was noted. At last follow-up, there was no significant difference between the percentage of residual shunts among the three groups (p = 0.135).CONCLUSIONS: Postsurgical residual VSDs less than 2 mm closed spontaneously in the majority within a year. Defects greater than 2 mm are unlikely to close spontaneously. Residual shunts after atrioventricular septal defect repair almost always close, whereas one third will remain open after Fallot or isolated VSD repair. At midterm follow-up, residual shunts remained hemodynamically and clinically irrelevant. Revision of a residual defect greater than 2 mm on cardiopulmonary bypass at initial repair, guided by TEE, may spare late redo surgery and lifelong antibiotic prophylaxis.

KW - Cardiac Surgical Procedures

KW - Child

KW - Child, Preschool

KW - Echocardiography

KW - Echocardiography, Transesophageal

KW - Follow-Up Studies

KW - Heart Septal Defects, Atrial/complications

KW - Heart Septal Defects, Ventricular/complications

KW - Humans

KW - Infant

KW - Intensive Care Units

KW - Intraoperative Period

KW - Postoperative Period

KW - Remission, Spontaneous

KW - Retrospective Studies

KW - Tetralogy of Fallot/complications

KW - Time Factors

U2 - 10.1016/j.athoracsur.2006.09.086

DO - 10.1016/j.athoracsur.2006.09.086

M3 - SCORING: Journal article

C2 - 17307430

VL - 83

SP - 902

EP - 905

JO - ANN THORAC SURG

JF - ANN THORAC SURG

SN - 0003-4975

IS - 3

ER -