The Value Of Surgical Treatment Of Ventricular Septal Defect Complicated With Pneumonia In Infant

Objective: Ventricular septal defect(ventricular septal defect,VSD)is the most common congenital heart disease.It is accounted for 20%~57% of all congenital heart disease[1].The effect of surgical treatment is well.If there is no special complications,the general choice for infants with congenital heart disease is taking surgical treatment before school.But due to the young age,low birth weight,developmental immaturity of the whole body,infants with anatomical malformation of the heart,left to right shunt congenital heart diseases show the pulmonary circulation congestion,pulmonary hypertension which do the further damage to the heart and lung function.In the early times the infants above get RTI(respiratory tract infection)easily.But it can rapidly develop to severe pneumonia,and even death.Some patients has no significant improvement after treatment of internal medicine,even be complicated with multiple organ failure,which are endanger the lives.In recent years,with the continuous improvement of the surgery,anesthesia,cardiopulmonary bypass and monitoring devices,surgical indications of congenital heart disease continue to relax.The infants with congenital heart disease such as recurrent pneumonia respiratory failure,heart failure,no improvement after internal medicine treatment are recommended as soon as possible to take surgery to block left to right shunt,promote the recovery of inflammation and avoid damage to the damage of vital organs.From January 2014 to April 2015,we took 60 cases of infants with ventricular septal defect complicated with pneumonia for analysis in our hospital.We divided them into two groups according to whether with tracheal intubation in emergency operation.All of them took underwent surgical treatment.The effect is good.We analyzed the clinical diagnosis and surgical date,discussed the appropriate time for surgery,the treatment of intraoperative and postoperative of surgery to reduce the mortality,hospitalization days and improve the quality of infants life.Methods: From January 2014 to April 2015 in our hospital,we have treated 60 cases of ventricular septal defect infants complicated with pneumonia.There were 26 cases of male patients,34 cases of female patients between 0.7~10(4.5±2.3)months.Their body mass were between 3.3 to 10.67(5.07±2.04)kg.According to whether with tracheal intubation in emergency operationwere they were divided averagely into two groups.We taked VSD repair treatment under extracorporeal circulation with general anesthesia.At the same time we treated the heart malformation and observed clinical index to compare.Results: 29 of the 30 which were accounted for 96.6% in elective surgery group were cured.1 cases of infants' families gave up treatment for economic problems.The other patients had a good recovery after operation.Time of discharge after surgery was 6~16 d,the average time was(9.50±3.27)d,The residence time in CICU was 2 ~ 15(6.4±3.2)d,The using ventilation mechanical time were 9~335h(88.1±60.9)h.The total hospitalization were 9~29(15.5±5.1).There were 2 patients died in 30 patients of emergency operation group.The other were cured.There were one death during the perioperative period,one death in early follow-up.Case of fatality rate was 6%.Time of discharge after surgery was 6~17 d.The average time was(9.60±2.41)d.The residence time in CICU was 4~16(7.3±2.7)d.The using ventilation mechanical time were 23.7 ~ 219.8(101.5±44.7)h.The total hospitalization were 12~34d(20.7±6.4)?We compared the aortic clamping time,CPB time,postoperative mechanical ventilation time ICU time between two groups.But there were no significant difference.postoperative complication were usually secondary tracheal intubation,low cardiac output,arrhythmia,pulmonary infection,atelectasis,chylothorax,surgical site infection.Outpatient department followed up the patients 6 months for their weight,height and prevalence.We found that growth and development of both groups patients were significantly speeded up and physique was enhanced.One or two months after surgery we followed up their electrocardiogram(ecg)and found no obvious abnormity.Based on colour doppler ultrasound of heart,we found they all had good recovery.Conclusion: For most infants with ventricular septal defect complicated pneumonia,they can be cured by elective surgery after medical therapy.But some infants should be better taken surgery as early as possible for the small age,big defect,pneumonia,heart function that can't be controlled.Early surgery can reduce mortality,improve survival quality and reduce the financial burden on families.