HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Suresh G. Rao Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bhatt, M. Articles by Rao, S. G. Search for Related Content PubMed PubMed Citation Articles by Bhatt, M. Articles by Rao, S. G. Related Collections Congenital - acyanotic

J Thorac Cardiovasc Surg 2004;127:1466-1473
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Management of infants with large, unrepaired ventricular septal defects and respiratory infection requiring mechanical ventilation

^a Departments of Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India,
^b Department of Anesthesiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India,
^c Department of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
^d Department of Cardiology, Children's Hospital Boston, and the Department of Pediatrics, Harvard Medical School, Boston, Mass, USA

Received for publication August 11, 2003; revisions received October 10, 2003; accepted for publication November 6, 2003.

^* Address for reprints: R. Krishna Kumar, MD, DM, Amrita Institute of Medical Sciences and Research Centre, Kochi 682026, Kerala, India
rkrishnakumar{at}aimshospital.org

OBJECTIVES: We sought to describe the hospital management and early outcome of critically ill infants presenting with large ventricular septal defects and pneumonia requiring mechanical ventilation at a referral center in a developing country. Infants with large ventricular septal defects who have pneumonia might present with respiratory failure requiring mechanical ventilation. In the developing world this presentation is relatively common, but few data exist describing patient management strategies.

METHODS: Hospital data of consecutive infants admitted with large ventricular septal defects and pneumonia requiring mechanical ventilation were reviewed and analyzed.

RESULTS: We identified 18 infants (mean age, 3.6 ± 3.0 months). On admission, all the infants were significantly malnourished, and echocardiography showed bidirectional shunting (predominantly right-to-left shunting) in 6 infants. Thirteen (72%) patients improved with intensive medical management that included mechanical ventilation for 1 to 16 days (median, 6.5 days); unequivocal left-to-right shunting was subsequently documented by means of echocardiography in all 13 patients. Twelve patients underwent surgical repair, and 11 (91.6%) were discharged after median mechanical ventilation of 100 hours (range, 42-240 hours) and intensive care unit stay of 8 days (range, 4-15 days). Five of 6 unoperated patients died, 4 of them within a few hours of admission. One child with multiple ventricular septal defects was discharged and subsequently underwent pulmonary artery banding.

CONCLUSION: Corrective cardiac surgery for selected critically ill infants with large ventricular septal defects, severe malnutrition, and pneumonia requiring mechanical ventilation is feasible and should be considered a viable management strategy.

This article has been cited by other articles:

				R K Kumar and S Shrivastava Paediatric heart care in India Heart, August 1, 2008; 94(8): 984 - 990. [Abstract] [Full Text] [PDF]