Investigation Of The Main Complications And Correlation Factors After Repair Of Ventricular Septal Defect(VSD)

Objective:To explore the main complications and correlation factors after VSD repair.Methods:A retrospective analysis was made in 19 cases of residual shunt,6 cases ofⅢ°atrioventricular block,5 cases of tricuspid valve regurgitation after VSD repair of 1100 congenital VSD and tetralogy of Fallot(TOF)which were admitted into our hospital from 1994 to 2006.Results:1 19 cases of residual shunt occurred with the incidence being 1.7%.8 cases were reoperated and their murmur disappeared after reoperation;of them most of the residual shunt occurred in the right and left ends of defect which were closured directly with mattres sutures,and around the base of anterior and septal leaflets of tricuspid valve which were closured with patch.In other 11 cases followed up after surgery from 1 year to 6 years,2 cases closured spontaneously(2mm,3mm),2 cases became smaller and 7 cases unchanged.2 6 cases ofⅢ°atrioventricular block occurred with the incidence being 0.55%,all of which were closured with patch.Of them 3 cases resumed normal sinus rhythm in 7 days,2 cases implanted permanent pacemaker on 1 month after surgery, and 1 case was followed up well.3 5 cases of tricuspid valve regurgitation occurred with the incidence being 0.45%,all of which were closured with patch.2 cases consisting with residual shunt were reoperated,and both of them had presented the mild tricuspid valve regurgitation before the first operation;one of them had septal leaflet laceration of tricuspid valve which was repaired,and the other had the patch pressing on anterior chordae which was given solution.3 cases were followed up well after surgery from 1 year to 5 years with no one aggravated.Conclusion:1 The main complications after VSD repair include residual shunt,block of conduction and valve regurgitation.2 The operation skills are the main cause of residual shunt after VSD repair.Other important cause includes omission of VSD,bad exposure and endocarditis.3 The incidence of block of conduction after VSD repair is related to the damage of the conductive system during operation and the local operation trauma,of themⅢ°atrioventricular block is the core feature.4 The valve regurgitation after VSD repair includes tricuspid and aortic valve regurgitation.The main cause of tricuspid valve regurgitation is the injury of septal leaflet and chordae of tricuspid valve,and aortic valve regurgitation is the injury of valve leaflet and ring of aortic valve.