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Chapter 2 - Ventricular Septal Defect

from Section 1 - Left-to-Right Shunts

Published online by Cambridge University Press:  09 September 2021

Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

Ventricular septal defects are the most common congenital heart defect, occurring in 50% of patients with congenital heart disease. They may occur in isolation or be part of a constellation of complex cardiac defects. An isolated ventricular septal defect results in the ability to shunt blood between the left and right ventricles. The size of the defect and pulmonary vascular resistance determine blood flow across the defect. Timing for the surgical repair of a ventricular septal defect varies based on patient age and symptomatology as well as the size and location of the lesion, with most nonrestrictive defects closed within the first few years of life to avoid long-term pulmonary sequelae that can lead to eventual shunt reversal and Eisenmenger syndrome. This chapter discusses the implications of caring for a preterm infant with an unrepaired ventricular septal defect for non-cardiac surgery. An understanding of factors impacting pulmonary vascular resistance and systemic vascular resistance is vital to the anesthetic management of the patient with a large ventricular septal defect.

Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
, pp. 9 - 13
Publisher: Cambridge University Press
Print publication year: 2021

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References

Suggested Reading

Abdulhai, S. A., Glenn, I. C., and Ponsky, T. A. Incarcerated pediatric hernias. Surg Clin North Am 2017; 97: 129–45.CrossRefGoogle ScholarPubMed
Corno, A. F. and Festa, P. Ventricular septal defect. In Congenital Heart Defects: Decision Making for Cardiac Surgery. Volume 3: CT Scan and MRI. Heidelberg: Steinkopff, 2003; 4955.Google Scholar
Latham, G. J. and Yung, D. Current understanding and perioperative management of pediatric pulmonary hypertension. Pediatr Anesth 2019; 29: 441–56.CrossRefGoogle ScholarPubMed
Minette, M. S. and Sahn, D. J. Ventricular septal defects. Circulation 2006; 114: 2190–7.Google Scholar
Rosenthal, D. N. and Hammer, G. B. Cardiomyopathy and heart failure in children: anesthetic implications. Pediatr Anesth 2011; 21: 577–84.CrossRefGoogle ScholarPubMed
Taylor, D. and Habre, W. Risk associated with anesthesia for noncardiac surgery in children with congenital heart disease. Pediatr Anesth 2019; 29: 426–34.Google Scholar

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