Doppler color flow mapping assessment of residual shunt after closure of large ventricular septal defects.

Abstract

Of 179 consecutive patients who underwent closure of a large ventricular septal defect (VSD) as part of reparative surgery under 2 years of age, 19 died early and 160 had echocardiographic evaluation that included Doppler color flow mapping at 8 +/- 7 days after repair. Sixty-one (38%) of patients had evidence of residual shunting in the peripatch area. Two independent observers measured the Doppler color jet width at the left septal surface; jet width was correlated with subsequent reoperation for residual VSD. Patients were divided into two groups by jet width measurement: group 1 measured 4 mm or greater (n = 4), and group 2 measured less than 4 mm (n = 57). Of the group 1 patients, three returned to the operating room for a large residual defect; one patient died without reoperation but was confirmed to have had a large defect by angiography. Four patients in group 2 underwent surgery for a residual VSD; two underwent reoperation for reasons other than a residual VSD and had closure of a small residual VSD; one patient thought to have a large residual VSD at reoperation was noted to have multiple muscular VSD and only a small residual VSD; and one patient had a small defect initially but returned 2 years later with late patch dehiscence. Sixty-five percent of 23 group 2 patients reevaluated at a mean of 10 +/- 8 months after initial study no longer showed evidence of residual shunting. Residual Doppler color jets are frequently noted after repair of a large VSD.(ABSTRACT TRUNCATED AT 250 WORDS)