Wadile Santosh, Kondgekar Divya, Banpurkar Ashishkumar Moreshwar, Raeen Shahena Parveen, Kulkarni Komal, Kulkarni Snehal
Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India.
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.
Pediatr Cardiol. 2025 Mar;46(3):675-684. doi: 10.1007/s00246-024-03486-w. Epub 2024 Apr 18.
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.
婴儿期大型室间隔缺损（VSD）的闭合可使生长恢复正常，但相关数据有限。我们开展本研究以评估分流闭合术后不同年龄组儿童及低出生体重儿的生长模式。这是一项前瞻性观察性研究，纳入了在婴儿期接受孤立性大型VSD手术的婴儿。在基线和随访时收集人体测量数据，并分析生长模式。99名婴儿纳入本研究。手术时的平均年龄和体重分别为6.97±2.79个月和5.07±1.16千克。平均随访时间为8.99±2.31个月。术前年龄别体重（W/A）是受影响最严重的参数，分流闭合术后W/A的平均Z评分有显著改善（-3.67±1.18对-1.76±1.14，p=0.0012）。年龄别身长（L/A）和身长别体重（W/L）的Z评分有所改善，尽管无统计学意义。所有年龄组的婴儿在人体测量参数方面均有统计学显著增长。8个月以下接受手术的婴儿体重增加率最高（2 - 4个月 = 3588克，5 - 6个月 = 3592克，7 - 8个月 = 3606克，9 - 10个月 = 2590克，11 - 12个月 = 2250克）。低出生体重儿和正常出生体重儿在手术时及随访时所有3项人体测量参数的Z评分相似，出生体重不影响术前及术后生长参数。即使手术修复成功，仍分别有40%和20%的婴儿体重和身长改善欠佳。大型VSD婴儿的生长发育迟缓可能是多因素导致的。早期手术闭合分流可使生长参数早日恢复正常并实现更快的追赶生长。即使及时进行手术矫正，仍有少数婴儿可能未表现出积极的生长反应，这可能与宫内和遗传因素或不良喂养习惯有关。
