الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 54 |  |  |
| | | from | 54 | | |
Abstract
VSDs are the most prevalent congenital cardiac anomaly requiring surgical intervention. Surgical closure of isolated ventricular septal defects is safe, but not without potential complications. Residual defects after surgical closure is not uncommon, and represent a concern for the parents and the treating physician as it represents a primer for more serious complications and may require repeat intervention. Our study evaluated the incidence of residual defects after surgical closure of isolated VSDs and the factors determining the presence of such defects.
We performed a prospective study including 30 patients admitted for our hospital for surgical closure of isolated ventricular septal defects from November 2017 to December 2018. We recorded patients’ characters namely gender, age, body weight, presence of Down syndrome and prior PAB, echocardiographic data including type and size of VSD, pulmonary hypertension and valvular pathologies, operative data including patch material, method of closure, operative time and TEE findings, as well as postoperative data including mortality, ICU stay and TTE findings. We evaluated the incidence of residual lesions after surgery and potentially significant factors that might contribute to such incidence.
Residual defects were detected in 7 patients (23%) by intraoperative TEE, with mean size 1.79 ± 0.49 mm. Most of them were deemed small with insignificant shunting necessitating no further intervention. Postoperative TTE findings showed discrepancy in two patients with residual lesions, and only one required readmission for surgery based on clinical and echocardiographic findings of significant shunting. Lower body weight was a significant predictor of the incidence of residual lesions (p = 0.041), and synthetic patches were correlated with higher incidence, though no significance could be affirmed. The majority of residual lesions (83%) closed spontaneously at a limited period of follow-up of 6 months, and the size of the lesion was a significant factor that influenced the propensity of spontaneous closure (p = 0.047).
We concluded that although residual lesions can significantly afflict surgical closure of isolated VSDs, the majority are hemodynamically insignificant and require no surgical reintervention. Moreover, most of the residual lesions will close spontaneously at follow-up without being associated with major complications or negative impact of patients’ well-being. Proper selection of sound technique, patch material and adopting routine use of intraoperative TEE can contribute to optimizing surgical outcomes and lessening the incidence of such complication