Repair of ventricular septal defect in infants without ventriculotomy

Eighty-nine infants with clinical evidence of a large ventricular septal defect (VSD), refractory to conventional medical treatment, underwent surgical closure within the first 12 months of life from August 1987 to December 1991. There were 54 males and 35 females. The ages of the patients ranged from 2 to 12 months, with a mean age of 6.4 months. The mean body weight of the patients was 5.2 kg (range 2.3 to 10 kg). Surgery was performed because of intractable heart failure in 38 infants (43%), failure to thrive in 49 (55%), repeated pneumonia in 53 (60%) and prolonged endotracheal intubation in 10 (11%). There were 27 patients with a supracristal VSD (30%), and 62 patients with perimembranous VSD (70%). Eleven patients (12%) had pre-operative cardiac catheterization. Transatrial repair of perimembranous VSDs and transpulmonary repair of supracristal VSDs was used exclusively without ventriculotomy in our institution. Surgically induced heart block did not occur in any of the patients. Only 2 patients (2.2%) died during the early post-operative period. Diagnosis in most cases was confirmed by the present advanced integrated colour Doppler echocardiographic technology which is widely used by paediatric cardiologists. There is no need to perform cardiac catheterization in most patients with VSD. The morbidity and mortality were low. We strongly suggest that transatrial or transpulmonary primary repair without ventriculotomy can be successfully accomplished in almost all infants with a large VSD. Key words: ventricular septal defect, infant, surgery.