HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ali Dodge-Khatami René Prêtre Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dodge-Khatami, A. Articles by Bauersfeld, U. Search for Related Content PubMed PubMed Citation Articles by Dodge-Khatami, A. Articles by Bauersfeld, U. Related Collections Congenital - acyanotic Related Article

Ann Thorac Surg 2007;83:902-905
© 2007 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Spontaneous Closure of Small Residual Ventricular Septal Defects After Surgical Repair

^a Division of Congenital Cardiovascular Surgery, University Children’s Hospital, Zürich, Switzerland
^b Division of Pediatric Cardiology, University Children’s Hospital, Zürich, Switzerland
^c Division of Anesthesiology, University Children’s Hospital, Zürich, Switzerland
^d Department of Biostatistics, Institute for Social and Preventive Medicine, University of Zürich, Zürich, Switzerland

Accepted for publication September 25, 2006.

^_* Address correspondence to Dr Dodge-Khatami, University Children’s Hospital, University of Zürich, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland (Email: ali.dodge-khatami{at}kispi.unizh.ch).

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.

Related Article

Invited commentary

Kirk R. Kanter
Ann. Thorac. Surg. 2007 83: 906. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				K. R. Kanter Invited commentary Ann. Thorac. Surg., March 1, 2007; 83(3): 906 - 906. [Full Text] [PDF]