Background: Ventricular septal defect (VSD) is among the most common congenital heart anomalies. Now, primary VSD closure is the surgical treatment of choice for symptomatic patients. Long-standing and neglected cases of ventricular septal defects may develop progressive pulmonary obstructive disease with severe pulmonary hypertension which may affect surgical outcome significantly including mortality, morbidity and lifestyle. Methods: One hundred and sixty patients with VSD below two years old with a mean age of 12.44 ± 5.76 months and a mean weight of 7.77 ± 2.05 kgs, were operated upon and their preoperative, operative and postoperative data were studied. The patients were divided into two groups according to their preoperative mean pulmonary artery pressure. Group I < 55 mmHg (mild and moderate pulmonary hypertension) and Group II > 55 mmHg (severe pulmonary hypertension).
Results; Analysis of the data showed significant correlation between most of them with higher morbidity and mortality in Group II.
Conclusion: It is not safe to postpone surgical closure for large VSD or VSD with increased pulmonary flow after 1 year depending on patient’s clinical condition as the resulting increased pulmonary vascular resistance may reduces the amount of left-to-right shunt and partly ameliorates signs of heart failure. Early detection and surgical correction of patients with VSD and increased pulmonary flow is the best safeguard against progression or persistence of pulmonary hypertension and pulmonary vascular changes and consequently, early intervention gives us the best surgical outcome with the least complications and mortality, and with less hospital-stay and better life- style.
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