Original Articles
Outcome of ventricular septal defect repair in a developing country

https://doi.org/10.1067/mpd.2002.124304Get rights and content

Abstract

Objectives: To examine the impact of nutrition and lung infection on outcome early after ventricular septal defect (VSD) repair in infants in a developing country. Study design: One hundred consecutive infants (age, 7.4 ± 3.3 months) with large VSD(s) who underwent surgical repair at one institution in South India from July 1998 to June 2000 were analyzed. Primary outcome variables were postoperative death, duration of mechanical ventilation, intensive care unit (ICU) stay, and hospital stay. Preoperative variables analyzed included age, weight and length Z scores, and lung infection. Results: Preoperative nutrition was poor (weight Z score, −2.8 ± 1.3), and 25 patients had pneumonia. Six patients died after repair. No preoperative variable was associated with death. Mechanical ventilation, ICU stay, and hospital stay were longer for younger patients (rs for ventilation, −0.23, P =.02; for ICU stay, −0.33, P <.001; for hospital stay, −0.27, P =.007) and for those with preoperative pneumonia (median ventilation duration, 46 vs 24 hours, P <.001; median ICU stay 7 vs 4 days, P <.001; median hospital stay 10 vs 7 days, P =.001). Preoperative weight and length Z scores were not associated with any outcome variable. Conclusions: Poor nutritional status, preoperative pneumonia, and age do not increase mortality rates after VSD repair. Repair of large VSDs should not be delayed because of these preoperative characteristics. (J Pediatr 2002;140:736-41)

Section snippets

Study design

The clinical records of 100 consecutive infants (age, ≤12 months) who underwent VSD closure at our institute between July 1998 and June 2000 were retrospectively reviewed.

Setting

The study was conducted in the setting of a tertiary care referral hospital serving a population of approximately 30 million people in the state of Kerala in southern India. Approval for retrospective chart review was obtained from the hospital's medical records division.

Patients

Consecutive infants at our institution who underwent

Results

The average age at the time of surgery was 7.4 ± 3.3 months (range, 1-12 months) (Table I); 44 patients were ≤6 months of age.

. Preoperative condition of 100 infants undergoing VSD closure

Age (mo)*7.4 ± 3.3 (1-12)
SexMale 58%, female 42%
Weight at surgery (kg)*5.2 ± 1.3 (2.5-9.0)
Z score weight*−2.8 ± 1.3 (−5.6-3.3)
Length at surgery (cm)*64 ± 6.5 (49-94)
Z score length*−1.9 ± 2.0 (−6.7-3.2)
Associated syndromesTrisomy 21: 6%, others: 4%
VSD numberSingle 94%, multiple 6%
Restrictive VSD (VSD gradient >30

Discussion

There is little published information on the impact of preoperative conditions such as poor nutritional status and lung infection on postoperative outcome after open heart surgery in infants. The purpose of this retrospective study, conducted in a tertiary referral center in south India, was to determine whether severe malnutrition, recent lung infection, or younger age increased the morbidity and/or mortality rates of infants undergoing reparative surgery for large VSD(s).

The preoperative

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    Reprint requests: R. Krishna Kumar, MD, Consultant Pediatric Cardiologist, Amrita Institute of Medical Sciences and Research Center, Kochi 682026, Kerala, India.

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