The Journal of Thoracic and Cardiovascular Surgery, Vol 71, 392-397, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Repair of ventricular septal defect after pulmonary artery banding
W Seybold-Epting, GJ Reul Jr, GL Hallman and DA Cooley
Since 1964, 90 patients have undergone two-stage surgical repair of
ventricular septal defect (VSD) with pulmonary artery banding (PAB) in
early infancy and total repair at an average age of 4 years. Reconstruction
of the pulmonary artery was accomplished with a pericardial patch, woven
Dacron patch, or transverse angioplasty. The VSD was closed with a knitted
Dacron patch in 75 patients and by primary suture technique in 13 patients.
The VSD closed spontaneously in 2 patients. The mortality rate for patients
who had repair and debanding was 9 per cent (8 patients), including 4
deaths due to severe pulmonary hypertensive disease, 3 from congestive
heart failure, and one from atrioventricular block. Twenty patients
underwent repeat cardiac catheterization several months to 7 years after
total repair. This study revealed no shunt in 16 patients and a minimal
shunt not requiring operation in the other 4 children. Slight residual
stenosis of the pulmonary artery was found in 2 patients and a residual
infundibular stenosis in another 2 patients. We believe two-stage surgical
treatment of VSD in severely ill infants under one year of age is safe and
reliable.