Continuous three-stage method for the treatment of ventricular septal defects complicated by severe pulmonary hypertension

Abstract

Aim. To evaluate the effectiveness of a three-stage medical-surgical method for treating ventricular septal defect (VSD) with severe pulmonary hypertension (PH) in children, aimed at improving hemodynamics and reducing mortality.

Materials and Methods. The study included 112 patients (aged 3 months to 3 years, mean age 14.4 ± 0.6 months) with VSD complicated by severe PH, from the Department of Cardiac Surgery of the National Children’s Medical Center (December 2022 – December 2023). Diagnosis was confirmed by clinical findings, chest radiography, and echocardiography. The three-stage medical-surgical method included: first stage — 4-week conservative therapy (furosemide 1–3 mg/kg, captopril 0.1–0.3 mg/kg, cefazolin 1.0 g, sildenafil 0.3–1 mg/kg); second stage — radical surgery in 61 patients (54.5%) (38 — classic VSD patch repair, 23 — optimized repair using a patch holder); third stage — postoperative therapy (furosemide, digoxin, dopamine/dobutamine, captopril, cefazolin). Surgeries were performed under cardiopulmonary bypass with hypothermia (32°C).

Results. Hemodynamic stabilization was achieved in 61 (54.5%) of 112 patients who subsequently underwent surgery: 38 classic repairs and 23 optimized repairs. The remaining 51 (45.5%) continued with repeated therapy. The optimized method reduced CPB time by 12.4% (12.5 minutes) and aortic cross-clamp time by 16.9% (10.2 minutes). No complications occurred; mortality was 3.3%.

Conclusion. The continuous three-stage medical-surgical method for treating VSD complicated by severe PH in children shows high effectiveness. It stabilizes preoperative hemodynamics, prevents progression of heart failure, and reduces mortality. The optimized VSD repair technique with a patch holder simplifies the procedure and shortens operative time. Hospital mortality was 3.3%, with deaths related to preoperative condition rather than surgical technique. No recurrences were recorded during three months of follow-up. Further studies are required to confirm long-term safety and efficacy, particularly in younger children.