Pulmonary Hypertensive Vasculopathy - No Indication for Corrective Operation of Isolated Ventricular Septum Defect in Babyhood

Summary The frequency of surgical closure of a ventricular septum defect (VSD) in the first year of life has risen from 10% to 30% in the last seven years in West Germany. Whereas there was a dccrease of mortality in older children, mortality has stagnated at 8% for correction at age 12 months or lcss (early correction). Development of an irreversible pulmonary hypertensive vasculopathy (PHVP) and recurrent heart failure with growth disorders are given as reasons for operation in the first year of life. In the last six years, we have operated on 31 infants for isolated VSD with pulmonary hypertension (PH) and closed the VSD. In approximately equal preoperative pressure in the two ventricles with a pressure ratio of 0.88 ± 0.16, there was an immediate fall in pressure in the right ventricle with pressure ratios of 0.43 ± 0.24. Three patients (9.7%) died perioperatively. In the same period, a primary VSD closure was carried out in 120 children even after over 12 months with three deaths (2.5%). Pulmonary tissue removed in this operation did not show any PHVP in four patients (13%), grades 0 to 1 and I to II in 10 patients each (total 33%) and a PHVP grade II to III in six patients (20%). This PHVP is capable of full regression. An irreversible PHVP does not develop up to the end of the first year of life in isolated VSD with PH, so that the correction can be safely postponed to the beginning of the second year of life provided that recurrent heart failure with growth disorders does not compel earlier correction. In any other cases, “early correction” is an unnecessary risk. Banding of the pulmonary artery for prevention of PHVP is inappropriate and unnecessary in these children.