Skip to main content
SpringerLink
Log in

How do Age at the Surgery and Birth Weight Influence Post-Operative Anthropometric Parameters in Infants with Surgical Closure of Large Ventricular Septal Defects? A Prospective Cohort Study from a Lower-Middle-Income Country

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Closure of the large ventricular septal defects (VSD) in infancy can lead to normalization of growth, but data are limited. Our study is done to assess the growth pattern in different age groups of children and lower birth weight babies after shunt closure. This is a prospective observational study that included infants with isolated large VSD operated in infancy. Anthropometric data were collected at baseline and at follow-up, and growth patterns were analyzed. 99 infants were included in the study. The mean age and weight at the time of surgery were 6.97 ± 2.79 months and 5.07 ± 1.16 kg, respectively. The mean follow-up duration was 8.99 ± 2.31 months. The weight for age (W/A) was the most adversely affected parameter preoperatively, and there was significant improvement noted in the mean Z score for W/A after shunt closure (− 3.67 ± 1.18 vs. − 1.76 ± 1.14, p = 0.0012). There was improvement in Z-scores for length for age (L/A) and weight for length (W/L), although it was not statistically significant. The infants from all the age groups had statistically significant growth in the anthropometric parameters. The rate of weight gain was maximum in the infants operated below 8 months of age (2–4 months = 3588 g, 5–6 months = 3592 g, 7–8 months = 3606 g, 9–10 months = 2590 g, 11–12 months = 2250 g). Low birth weight and normal birth weight infants had similar Z-scores at the time of surgery and at follow-up in all 3 anthropometric parameters, and birth weight did not affect pre- as well as post-operative growth parameters. Suboptimal improvement in weight and length was seen in 40 and 20% of babies even after successful surgical repair, respectively. Growth failure in infants with a large VSD can be multifactorial. Early surgical closure of the shunt can lead to early normalization of growth parameters and faster catch-up growth. Few babies may fail to demonstrate a positive growth response even after timely surgical correction, and may be related to intrauterine and genetic factors or faulty feeding habits.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

ACC:

Aortic cross clamp

ASD:

Atrial septal defect

CCF:

Congestive cardiac failure

CHD:

Congenital heart defect

CPB:

Cardiopulmonary bypass

ICU:

Intensive care unit

L/A:

Length for age

LBW:

Low birth weight

LRTI:

Lower respiratory tract infection

PDA:

Patent ductus arteriosus

VSD:

Ventricular septal defect

W/A:

Weight for age

W/L:

Weight for length

References

  1. Wren C, Richmond S, Donaldson L (2000) Temporal variability in birth prevalence of cardiovascular malformations. Heart 83(4):414–419. https://doi.org/10.1136/heart.83.4.414

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Cresti A, Giordano R, Koestenberger M et al (2018) Incidence and natural history of neonatal isolated ventricular septal defects: do we know everything? A 6-year single-center Italian experience follow-up. Congenital Heart Dis 13(1):105–112. https://doi.org/10.1111/chd.12528

    Article  Google Scholar 

  3. Levy RJ, Rosenthal A, Fyler DC, Nadas AS (1978) Birthweight of infants with congenital heart disease. Am J Dis Child 132(3):249–254. https://doi.org/10.1001/archpedi.1978.02120280033007

    Article  CAS  PubMed  Google Scholar 

  4. Greenwood RD, Rosenthal A, Parisi L, Fyler DC, Nadas AS (1975) Extracardiac abnormalities in infants with congenital heart disease. Pediatrics 55(4):485–492

    CAS  PubMed  Google Scholar 

  5. Jacobs JP, Mayer JE Jr, Mavroudis C et al (2017) The society of thoracic surgeons congenital heart surgery database: 2017 update on outcomes and quality. Ann Thorac Surg 103(3):699–709. https://doi.org/10.1016/j.athoracsur.2017.01.004

    Article  PubMed  Google Scholar 

  6. Bhatt M, Roth SJ, Kumar RK et al (2004) Management of infants with large, unrepaired ventricular septal defects and respiratory infection requiring mechanical ventilation. J Thorac Cardiovasc Surg 127(5):1466–1473. https://doi.org/10.1016/j.jtcvs.2003.11.030

    Article  PubMed  Google Scholar 

  7. Levy RJ, Rosenthal A, Miettinen OS, Nadas AS (1978) Determinants of growth in patients with ventricular septal defect. Circulation 57(4):793–797. https://doi.org/10.1161/01.cir.57.4.793

    Article  CAS  PubMed  Google Scholar 

  8. Vaidyanathan B, Roth SJ, Gauvreau K, Shivaprakasha K, Rao SG, Kumar RK (2006) Somatic growth after ventricular septal defect in malnourished infants. J Pediatr 149(2):205–209. https://doi.org/10.1016/j.jpeds.2006.04.012

    Article  PubMed  Google Scholar 

  9. Manso PH, Carmona F, Jácomo AD, Bettiol H, Barbieri MA, Carlotti AP (2010) Growth after ventricular septal defect repair: does defect size matter? A 10-year experience. Acta Paediatr 99(9):1356–1360. https://doi.org/10.1111/j.1651-2227.2010.01801.x

    Article  PubMed  Google Scholar 

  10. Correia Martins L, Lourenço R, Cordeiro S et al (2016) Catch-up growth in term and preterm infants after surgical closure of ventricular septal defect in the first year of life. Eur J Pediatr 175(4):573–579. https://doi.org/10.1007/s00431-015-2676-4

    Article  PubMed  Google Scholar 

  11. Bloomfield DK (1964) The natural history of ventricular septal defect in patients surviving infancy. Circulation 29:914–955. https://doi.org/10.1161/01.cir.29.6.914

    Article  CAS  PubMed  Google Scholar 

  12. Schuurmans FM, Pulles-Heintzberger CFM, Gerver WJM, Kester ADM, Forget P-P (1998) Long-term growth of children with congenital heart disease: a retrospective study. Acta Paediatr 87:1250–1255. https://doi.org/10.1111/j.1651-2227.1998.tb00947

    Article  CAS  PubMed  Google Scholar 

  13. Menahem S (1972) The clinical growth of infants and children with ventricular septal defects. Aust Paediatr J 8(1):1–15. https://doi.org/10.1111/j.1440-1754.1972.tb01780.x

    Article  CAS  PubMed  Google Scholar 

  14. Collins G, Calder L, Rose V, Kidd L, Keith J (1972) Ventricular septal defect: clinical and hemodynamic changes in the first five years of life. Am Heart J 84(5):695–705. https://doi.org/10.1016/0002-8703(72)90186-x

    Article  CAS  PubMed  Google Scholar 

  15. Saxena A, Relan J, Agarwal R et al (2019) Indian guidelines for indications and timing of intervention for common congenital heart diseases: revised and updated consensus statement of the working group on management of congenital heart diseases. Ann Pediatr Cardiol 12(3):254–286. https://doi.org/10.4103/apc.APC_32_19

    Article  PubMed  PubMed Central  Google Scholar 

  16. Anderson BR, Stevens KN, Nicolson SC et al (2013) Contemporary outcomes of surgical ventricular septal defect closure. J Thorac Cardiovasc Surg 145(3):641–647. https://doi.org/10.1016/j.jtcvs.2012.11.032

    Article  PubMed  Google Scholar 

  17. Inohara T, Ichihara N, Kohsaka S et al (2019) The effect of body weight in infants undergoing ventricular septal defect closure: a report from the nationwide Japanese congenital surgical database. J Thorac Cardiovasc Surg 157(3):1132-1141.e7. https://doi.org/10.1016/j.jtcvs.2018.11.111

    Article  PubMed  Google Scholar 

  18. Kogon B, Butler H, Kirshbom P, Kanter K, McConnell M (2008) Closure of symptomatic ventricular septal defects: how early is too early? Pediatr Cardiol 29(1):36–39. https://doi.org/10.1007/s00246-007-9016-z

    Article  CAS  PubMed  Google Scholar 

  19. Bayer LM, Robinson SJ (1969) Growth history of children with congenital heart defects. Size according to sex, age decade, surgical status, and diagnostic category. Am J Dis Child 117(5):564–572. https://doi.org/10.1001/archpedi.1969.02100030566011

    Article  CAS  PubMed  Google Scholar 

  20. Weintraub RG, Menahem S (1991) Early surgical closure of a large ventricular septal defect: influence on long-term growth. J Am Coll Cardiol 18(2):552–558. https://doi.org/10.1016/0735-1097(91)90614-f

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors have not disclosed any funding.

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India

    Santosh Wadile, Divya Kondgekar, Ashishkumar Moreshwar Banpurkar, Shahena Parveen Raeen & Komal Kulkarni

  2. Head of Department of Paediatric Cardiology and Mentor, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India

    Snehal Kulkarni

Authors
  1. Santosh Wadile
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Divya Kondgekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashishkumar Moreshwar Banpurkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shahena Parveen Raeen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Komal Kulkarni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Snehal Kulkarni
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SW prepared the manuscript. DK contributed toward data collection and statistical analysis. AMB, SPR, and KK contributed toward dietary advice and patient follow-up. SK revised and finalized the manuscript.

Corresponding author

Correspondence to Snehal Kulkarni.

Ethics declarations

Conflict interest

The authors have not disclosed any competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 31 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wadile, S., Kondgekar, D., Banpurkar, A.M. et al. How do Age at the Surgery and Birth Weight Influence Post-Operative Anthropometric Parameters in Infants with Surgical Closure of Large Ventricular Septal Defects? A Prospective Cohort Study from a Lower-Middle-Income Country. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03486-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00246-024-03486-w

Keywords

Search

Navigation