1. Ventricular septal defect with congenital mitral valve disease: long-term results of corrective surgery.
- Author
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Agarwal S, Airan B, Chowdhury UK, Choudhary SK, Sharma R, Bhan A, Saxena A, and Venugopal P
- Subjects
- Adolescent, Adult, Child, Child Welfare, Child, Preschool, Female, Follow-Up Studies, Heart Septal Defects, Ventricular mortality, Heart Septal Defects, Ventricular surgery, Heart Valve Diseases mortality, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation, Humans, India epidemiology, Infant, Infant Welfare, Male, Middle Aged, Mitral Valve surgery, Recurrence, Reoperation, Retrospective Studies, Survival Analysis, Time, Time Factors, Treatment Outcome, Ventricular Outflow Obstruction congenital, Ventricular Outflow Obstruction mortality, Ventricular Outflow Obstruction surgery, Heart Septal Defects, Ventricular complications, Heart Valve Diseases congenital, Mitral Valve abnormalities
- Abstract
Background: A retrospective analysis of the mortality, morbidity and long-term follow-up of patients undergoing corrective surgery for ventricular septal defect and congenital mitral valve disease is presented., Methods and Results: Between January 1991 and December 2000, 69 consecutive patients aged 2 months to 45 years (median 18 months) underwent repair of ventricular septal defect and associated mitral valve disease. In 52 patients (75%), the ventricular septal defects were located in the perimembranous and subarterial area. Forty-six patients had congenital mitral incompetence and 23 had congenital mitral stenosis. The ventricular septal defect was repaired through the right atrium in all. Sixty-five patients underwent reconstruction of the mitral valve and 4 underwent primary mitral valve replacement. Another 4 patients underwent mitral valve replacement after a failed repair. Associated procedures included: patent ductus arteriosus ligation (n=12), aortic valve replacement (n=6), coarctation repair (n=13), interrupted aortic arch repair (n=1), atrial septal defect closure (n=17) and Takeuchi repair (n=1). There were 6 early deaths (8.6%). Three deaths were due to pulmonary arterial hypertensive crisis and one due to residual mitral stenosis. One death was due to intractable congestive heart failure. Another patient died due to persistent low cardiac output. Follow-up ranged from 6 months to 120 months (mean 64.4+/-33.6 months). Reoperation was required in 22 patients, mainly for recurrent/residual mitral valve dysfunction or hemodynamically significant left ventricular outflow tract obstruction. There were 4 late deaths, 2 due to residual mitral stenosis and the other 2 as a result of a thrombosed prosthetic valve. At 10 years, the actuarial survival rate was 850+/-5.0%, and freedom from reoperation was 45%+/-10.0%., Conclusions: Reconstruction of the mitral valve along with closure of VSD is possible in most cases. However, careful follow-up is recommended to detect changes in the mitral valve status over a course of time.
- Published
- 2002