Correction of cardiac congenital malformation with ventricular septal defect associated with pulmonary secondary hypertension

Abstract

The aim of study was the evaluation of the methods of diagnosis and treatment of the patients with ventricular septal defect associated with pulmonary secondary hypertension. During the 2008- 2009 years, in Heart Surgery Centre there had been treated 495 persons with cardiac congenital malformations from wich 269 patients have had ventricular septal defects (VSD) accompanied with left-right shunt with breed of the pressure in the pulmonary artery more than 38 mmHg (DopplerEchoCG). The age of the patients was from 2 moths to 29 years. From the total of patients with VSD, 95(35%) patients have had isolated VSD. In the 164 cases VSD was associated with: atrial septal defect (ASD) 79 (29%) patients, patent ductus arteriosus (PDA) 27 (10%) patients, aortic coarctation (CoA) 13 (5%) patients, multiple partnerships in 55 (21%) cases. For the settlement of the diagnosis there was applied to compulsory investigation: ECG in 12 derivations, X-ray thoracic and EchoCGDoppler. To the 24 (9%) of patients there was accomplished cardiac catheterism. As a result of the investigation there was established pulmonary hypertension of the I(WHO) degrees to 158 (32%) patients, the second (WHO) degrees to 203(41%) patients , third (WHO)degrees have had registered in 94 (19%) cases, the IV (WHO) degrees tracked down in the 40 (8%) cases, from which 17 patients with isosystemic tension in lung artery. There were established two cases of Eisenmeger Syndrome that had not been included in the study. The radical surgery was submissive 164 (61%) patients, the palliatives stages were done to 105 (39%) patients, from which ligature of PDA in 44 (42%) cases, the banding of pulmonary artery (Muller surgery) in 61 (58%) cases. The surgical treatment was effective in 248 (92%) cases of pathology with radical and staged surgery. The tension in pulmonary artery registered through Doppler-EchoCG in first days has diminished significantly. In five (2%) cases interfered after surgery complications with the decease of the patients. Rebinding was made (accomplished) in the 16 (6%) cases. The pulmonary hypertension secondary developed to the congenital heart disease with left-right shunt extinguish remains to be one of the most difficult problems of the heart surgery. The delay of the surgery leads to complications that can pay with the development of the Eisenmenger syndrome and decease of the patient.