Early To Mid-term Follow-up Of Residual Shunt After Ventricular Septal Defect Repair Of Children

Objective:To investigate the causes,common locations,prognosis,prognostic factors,and intervention timing of residual shunt after ventricular septal defect repair of children.Methods:A retrospective analysis was performed for the clinical data of 214 patients who underwent VSD repair in Children's Hospital of Chongqing Medical University from January 2013 to January 2017,including sex,age at the time of surgery,body weight,preoperative pressure difference between left and right ventricles,preoperative VSD shunt direction,patch material,cardiopulmonary bypass time,aortic occlusion time,size and location of residual shunt,and blood flow velocity of residual shunt.Univariate and multivariate Cox regression analysis were used to identify the influencing factors for spontaneous healing.Results: No intervention was performed for 214 patients with residual shunt;among these patients,148(69.15%)achieved spontaneous healing of residual shunt and 66(30.85%)did not achieve healing.Of all patients,80 had a residual shunt of 1mm?RS<2mm,among whom 57(71.25%)achieved spontaneous healing,and 115 had a residual shunt of 2mm?RS<3mm,among whom 81(70.43%)achieved spontaneous healing,15 had a residual shunt of 3mm?RS<4mm,among whom 9(60.00%)achieved spontaneous healing,other 4 had a residual shunt of ?4mm,only 1(25.00%)achieved spontaneous healing.The univariate Cox analysis showed that cardiopulmonary bypass time(P=0.045),aortic occlusion time(P=0.026),size of residual shunt(P=0.003),and blood flow velocity of residual shunt(P=0.006)were influencing factors for spontaneous healing of residual shunt(P<0.05).And the multivariate Cox regression analysis showed that size of residual shunt(P=0.004)and blood flow velocity of residual shunt(P=0.02)were main influencing factors for spontaneous healing of residual shunt.Conclusions: Residual shunt is commonly observed in the upper and lower edges of the patch and the interventricular septum.Most patients with a residual shunt <4mm can achieve spontaneous healing,and blood flow velocity of residual shunt and size of residual shunt are the main factors for spontaneous healing.Active intervention should be performed for patients with a residual shunt >4 mm which does not decrease during follow-up for more than 1 year or these with clinical symptoms.