[tri-med] FYI - Management of infants with large, unrepaired ventricular septal defects and respiratory infection requiring mechanical ventilation

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http://jtcs.ctsnetjournals.org/cgi/content/abstract/127/5/1466


J Thorac Cardiovasc Surg 2004;127:1466-1473
Management of infants with large, unrepaired ventricular septal defects and 
respiratory infection requiring mechanical ventilation 
Mahesh Bhatt, MDa, Stephen J. Roth, MD, MPHd, R. Krishna Kumar, MD, DMa,*, 
Kimberlee Gauvreau, ScDd, Suresh G. Nair, MDb, Suresh Chengode, MDb, 
Krishnanaik Shivaprakasha, MS, MChc, Suresh G. Rao, MS, MChc 
a Departments of Department of Pediatric Cardiology, Amrita Institute of 
Medical Sciences and Research Centre, Kochi, Kerala, India,
b Department of Anesthesiology, Amrita Institute of Medical Sciences and 
Research Centre, Kochi, Kerala, India,
c Department of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences 
and Research Centre, Kochi, Kerala, India
d Department of Cardiology, Children's Hospital Boston, and the Department of 
Pediatrics, Harvard Medical School, Boston, Mass, USA 

Received for publication August 11, 2003; revisions received October 10, 2003; 
accepted for publication November 6, 2003. * Address for reprints: R. Krishna 
Kumar, MD, DM, Amrita Institute of Medical Sciences and Research Centre, Kochi 
682026, Kerala, India 
rkrishnakumar@xxxxxxxxxxxxxxxx 

OBJECTIVES: We sought to describe the hospital management and early outcome of 
critically ill infants presenting with large ventricular septal defects and 
pneumonia requiring mechanical ventilation at a referral center in a developing 
country. Infants with large ventricular septal defects who have pneumonia might 
present with respiratory failure requiring mechanical ventilation. In the 
developing world this presentation is relatively common, but few data exist 
describing patient management strategies. 

METHODS: Hospital data of consecutive infants admitted with large ventricular 
septal defects and pneumonia requiring mechanical ventilation were reviewed and 
analyzed. 

RESULTS: We identified 18 infants (mean age, 3.6 ± 3.0 months). On admission, 
all the infants were significantly malnourished, and echocardiography showed 
bidirectional shunting (predominantly right-to-left shunting) in 6 infants. 
Thirteen (72%) patients improved with intensive medical management that 
included mechanical ventilation for 1 to 16 days (median, 6.5 days); 
unequivocal left-to-right shunting was subsequently documented by means of 
echocardiography in all 13 patients. Twelve patients underwent surgical repair, 
and 11 (91.6%) were discharged after median mechanical ventilation of 100 hours 
(range, 42-240 hours) and intensive care unit stay of 8 days (range, 4-15 
days). Five of 6 unoperated patients died, 4 of them within a few hours of 
admission. One child with multiple ventricular septal defects was discharged 
and subsequently underwent pulmonary artery banding. 

CONCLUSION: Corrective cardiac surgery for selected critically ill infants with 
large ventricular septal defects, severe malnutrition, and pneumonia requiring 
mechanical ventilation is feasible and should be considered a viable management 
strategy. 

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