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KMID : 0857220040080020422
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Journal of the Korean Pediatric Cardiology Society
2004 Volume.8 No. 2 p.422 ~ p.429
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Surgical Experience of the Anteriorly Malaligned Large Ventricular Septal Defect Combined with Pulmonary Hypertension(Eisenmenger-Type VSD)
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Kim Jong-Woo
Rhie Sang-ho
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Abstract
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Purpose: Eisenmenger-type ventricular septal defect(VSD) is characterized by an anteriorly malaligned large VSD(dextroposition of aorta) without narrowing of the pulmonary conus combined with severe pulmonary hypertension. The patients with this defect usually shows very poor clinical courses despite of medical treatment, therefore timing of the surgical intervention tends to be delayed. This study is to evaluate the perioperative clinical outcome of the disease and its operative timing.
Methods: Among the 260 patients with VSD operated on during 15.8 years, thirteen patients(5.0%) were proved to have Eisenmenger-type VSD. The age of the patients ranged between 3.2 and 27.4(median 7.0) months. Ten patients(76.9%) were in growth retardation under 3 percentile. Preoperative and postoperative pulmonary arterial pressures and clinical courses were analyzed.
Results: Echocardiography or angiocardiographical findings of overriding of aorta ranged from 30 to 50%. The size of the VSDs were large(ranged from 7 to 22 mm, mean 12.8±4.0 mm). Postoperative pulmonary artery pressure(PAP) lowered to 30-46 mmHg (mean 37.2±5.3, N=9) at rest in intensive care unit from preoperative 44-95 mmHg(mean 73.2±14.5, N=9). The mean ratio of PAPs to systemic ones was also reduced from 0.85±0.15 to 0.39±0.05(P=0.008). No postoperative pulmonary artery hypertensive crisis and surgical mortality occurred.
Conclusion: Surgical outcome of the Eisenmenger-type VSD was excellent even though the patients with this defect had grave clinical symptoms of congestive heart failure, severe respiratory illness, poor intake and marked physical growth retardation preoperatively. The authors recommend early surgical intervention for this type of lesion rather than postponing operation with medical treatment.
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KEYWORD
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Eisenmenger-type ventricular septal defect, Anteriory malaligned ventricular septal defect, Tetralogy of Fallot, Pulmonary hypertension
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