Ventricular septal defect (VSD) is the most commonly diagnosed congenital heart defect presenting with failure to thrive. Surgical closure of the defect is the treatment of choice for these patients and should be done preferably in infancy. We present our experience of 84 patients of isolated VSD below one year of age treated in our hospital over period of four years. The median age of patient was 8 months (range 2 months to 11.5 months) and a median weight of 5 kg (range 2.5 kg to 9 kg). The following VSD types were found: 74 perimembranous (88%), 2 supracristal (2.3%), 3 inlet (3.5%) and 5 muscular (5.9%). Most common indication was recurrent pneumonias and failure to thrive. Pulmonary artery hypertension was present in 55 patients (65%) out of 84.

None of our patient was re-operated for residual VSD. Median extubation time was 12 hours (range  6 hours to 30 hours), median ICU stay was 3 days (range 2 to 15 days) and median hospital length of stay was 5 days (range  4 to 26 days). There were 2 early  mortalities (2.3%) and 1 late death (1.15%) in our series. 1 patient developed complete heart block requiring permanent pacemaker implant. 50 patients were discharged on medication for pulmonary hypertension. Pulmonary hypertension regressed over median time of 2 months. On median follow up of 2 years, 80 patients (95%) were asymptomatic. No patient had new onset aortic or tricuspid regurgitation greater than trivial postoperatively.

We concluded early surgical closure of VSD in infancy is treatment of choice for patients with VSD with low mortality and extremely low incidence of adverse events. 

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Dr Narender Singh Jhajhria

Prof Dept of CTVS, Dr RML Hospital, New Delhi, India

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