Early postoperative heart remodeling in children with ventricular septal defects

The present study investigates the phenomenon of the early postoperative left ventricular (LV) remodeling in children of the first year of life after radial correction of interventricular nonrestrictive defects. Based on dynamic evaluation of the heart chamber volumes and LV wall thickness in children of different age, it has been shown that a sharp decrease in postoperative LV volume was more common in children of the first year of life. Postoperative LV remodeling was encountered in 58% of infants and in 39% of older children. Increased left ventricular wall thickness in the early postoperative period was the main cause of diastolic heart failure which manifested hemodynamically as reduced cardiac index with preserved normal LV ejection fraction. Heart remodeling occurred more often in children with underweight and growth impairment. It has been found that a decrease in left atrial volume (relatively to the proper values) before surgery increased the risk of the early LV remodeling. Children with ventricular septal defect (VSD) without significant increase in left ventricular volume (less than 160% of proper values) and the preservation of the normal diameter of the truncus have substantially higher risk of early postoperative heart remodeling.