SURGICAL OUTCOME OF INFANTS WITH VENTRICULAR SEPTAL DEFECT AND PULMONARY HYPERTENSION IN A PEDIATRIC TERTIARY CARE HOSPITAL OF PUNJAB, PAKISTAN

Abstract

Background: In middle and low income countries, infants with large Ventricular Septal Defect (VSD) Pulmonary Hypertension (PH) present late and have multiple co-morbidities,hence pose significant issues in peri and post-operative period.The purpose of this study is to assess the results of infants undergoing corrective surgery for VSD and PH in a tertiary care Children’s Hospital paying considerable attention to the pre-operative and post-operative factors.

Methods: A chart review of 45 infants with VSD and PH was done over a one-year period. Inpatient variables including gender, age, pre and post -operative PA pressure, LVEF, associated cardiovascular lesions,use of pulmonary vasodilators, surgical indices and outcome were studied.

Results: The mean age was 10.5 months. Pulmonary artery pressure average pre-operatively was 45.3mm Hg, which reduced to 28.7 mmHg post-operatively. There were the associated lesions(PDA,ASD) in 25% of cases. On the surgery side, measurements of aortic cross clamp time and cardiopulmonary bypass time were taken, as well as documentation of postoperative complications. Preoperativedeath was seen in 11% of patients, mostly related to low cardiac output. Individual interviews with the survivors showed that most of them had a smooth recovery but some of the survivals experienced repeated infections and need for medication

Conclusion: The surgical risks for infants with VSD and PH are numerous. Preoperative preparation, intraoperative care, and postoperative care play pivotal role in enhancing the results. Subsequent follow up is crucial in assessing the progress in healing as well as treatment of long term effects