Early- to mid-term follow-up of residual shunt after ventricular septal defect repair in children：an analysis of 239 cases

Abstract:

Objective：To investigate the causes，common locations，prognosis，prognostic factors，and intervention timing of residual shunt after ventricular septal defect（VSD） repair in children. Methods：A retrospective analysis was performed for the clinical data of 239 patients with residual shunt who underwent VSD repair in The Affiliated 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 the left and right ventricles，preoperative VSD shunt direction，patch material，cardiopulmonary bypass time，size and location of resid－ual shunt，and blood flow velocity of residual shunt. Univariate and multivariate Cox regression analyses were used to identify the in－fluencing factors for prognosis. Results：No intervention was performed for 239 patients with residual shunt；among these patients，155 （64.85%） achieved spontaneous healing of residual shunt and 84 （35.15%） did not achieve healing. Of all patients，219 had a resid－ual shunt of <4 mm，among whom 153（69.86%） achieved spontaneous healing，and 20 had a residual shunt of >4 mm，among whom only 2（10%） achieved spontaneous healing. The univariate Cox regression analysis showed that preoperative pressure difference between the left and right ventricles（P=0.028），cardiopulmonary bypass time（P=0.006），size of residual shunt（P=0.003），and blood flow velocity of residual shunt（P=0.00） were influencing factors for prognosis（P<0.05），and the multivariate Cox regression analy－sis showed that cardiopulmonary bypass time（P=0.017） and blood flow velocity of residual shunt（P=0.019） were the main influencing factors for prognosis. Conclusion：Residual shunt is commonly observed in the upper and lower edges of the patch and the interventricular septum. Most patients with a residual shunt of <4 mm can achieve spontaneous healing，and blood flow velocity of residual shunt and cardiopulmonary bypass time are the main influencing factors for prognosis. Active intervention should be performed for patients with a residual shunt of >4 mm which does not decrease during follow-up for more than 1 year or those with clinical symptoms.