THE EFFECTS ON PULMONARY ARTERY PRESSURE OF EARLY SURGICAL REPAIR OF VENTRICULAR SEPTAL DEFECT IN SMALL CHILDREN

Objective: Significant changes have occurred in the management of pediatric patients with ventricular septal defect such as early surgical repair of the de- fects. The objective of this study was to investigate the effects of early closure of isolated ventricular septal defects on pulmonary artery pressure. Materials and Methods: Forty-nine patients undergoing surgery due to vent- ricular septal defects between January 2001 and January 2004 were enrolled in the study. The patients were classified into two groups in terms of their age at the time of the operation. Those who had been operated on before the age of 2 formed Group 1 (n=24) and those who had been operated on after the age of 2 formed Group 2 (n=25). Preoperative and postoperative (at 1 year) echo- cardiographic measurements of pulmonary artery pressure values were recor- ded for all patients. Results: No statistically significant differences were found between groups 1 and 2 in terms of preoperative pulmonary artery pressure or pulmonary vascu- lar resistance values. However, mean postoperative pulmonary artery pressure values were significantly lower in Group 1 (24.41 ± 0.63 mmHg) when compa- red with those in Group 2 (37.06 ± 1.53 mmHg) (p = 0.0001). No early or late mortality occurred in the groups during a mean follow-up period of 2 years. Conclusion: Our results suggest that surgery is more beneficial at an earlier age before the onset of pulmonary vascular disease. Surgery at an early age, if possible during infancy, may offer an opportunity to lead a nearly normal life for patients with VSD. Key Words: Ventricular Septal Defect, Pulmonary Hypertension, Surgical Re- pair.. KUCUK COCUKLARDA VENTRIKULER SEPTAL DEFEKTIN ER- KEN CERRAHI ONARIMININ PULMONER ARTER BASINCI UZE- RINDEKI ETKILERI OZ Amac: Ventrikuler septal defektli pediatrik hastalarin tedavisinde, defektlerin erken cerrahi onarimi gibi onemli degisiklikler olmustur. Bu calismanin amaci, izole ventrikuler septal defektlerin erken kapatilmasinin pulmoner arter basinci uzerindeki etkilerinin arastirilmasidir. Gerec ve Yontem: Ocak 2001 - Ocak 2004 arasinda ventrikuler septal de- fect nedeniyle cerrahi tedavi uygulanan 49 hasta calismaya dahil edildi. Hata- lar ameliyattaki yaslarina gore iki gruba ayrildi. Iki yasindan once opera edi- len hastalar Grup 1 (n=24), 2 yasindan sonar opere edilenler Grup 2’yi (n=25) olusturdu. Preoperatif ve postoperatif (1.yil) ekokardiyografik pulmoner arter basinci degerleri tum hastalar icin kaydedildi. Bulgular: Preoperatif pulmoner arter basinci ve pulmoner vaskuler rezistans degerleri acisindan grup 1 ve 2 arasinda istatistiksel olarak anlamli bir fark bu- lunmadi. Buna karsin, ortalama postoperative pulmoner arter basinc degerleri- nin Grup 1’de (24,41 ± 0,63 mm-Hg) Grup 2 (37,06 ± 1,53mm-Hg) ile karsilas- tirildiginda belirgin olarak dusuk oldugu gozlendi (p = 0.0001). Gruplarda orta- lama iki yillik izlem suresince erken veya gec mortalite olusmadi. Sonuc: Sonuclarimiz operasyonun erken yasta , pulmoner vaskuler hastalik baslangicindan once daha yararli oldugunu gostermektedir. Erken yasta, mum- kunse infant doneminde cerrahi tedavi VSD’li hastalar icin normale yakin bir yasam surme sansi saglayabilmektedir. Anahtar Kelimeler: Ventrikuler Septal Defekt, Pulmoner Hipertansiyon, Cer- rahi Onarim.