diagnosis journal

ABSTRACT
Background: Ventricular septal defect (VSD) is one of the most common congenital heart conditions in children. The timing of surgical intervention remains a critical factor influencing outcomes. While early surgery may prevent complications such as pulmonary hypertension and heart failure, late intervention allows for spontaneous closure in some cases. However, the optimal timing for surgical repair remains a topic of debate.
Aim: This study aimed to compare the clinical outcomes of early versus late surgical intervention in children diagnosed with VSD, focusing on post-operative complications, recovery time, and long-term cardiac function.
Methods: A prospective cohort study was conducted at Mayo Hospital, Lahore, from October 2023 to September 2024. A total of 50 children with VSD were included and categorized into two groups: early intervention (surgery before 12 months of age, n=25) and late intervention (surgery after 12 months of age, n=25). Postoperative complications, duration of mechanical ventilation, length of hospital stay, and echocardiographic parameters were assessed. Statistical analysis was performed using SPSS 25, with a p-value <0.05 considered significant.
Results: The early intervention group had a significantly lower incidence of post-operative pulmonary hypertension (12% vs. 36%, p=0.03) and shorter mechanical ventilation duration (8.2 ± 2.1 hours vs. 12.5 ± 3.8 hours, p=0.01) compared to the late intervention group. Additionally, the length of hospital stay was significantly shorter in the early surgery group (6.4 ± 1.5 days vs. 9.1 ± 2.3 days, p=0.02). However, late intervention was associated with a slightly higher rate of spontaneous VSD closure before surgery (20%). Long-term cardiac function, assessed via left ventricular ejection fraction at six months post-surgery, showed no significant difference between the two groups (62.8% vs. 61.5%, p=0.45).
Conclusion: Early surgical intervention for VSD resulted in better short-term outcomes, including reduced pulmonary hypertension, shorter ventilation duration, and a shorter hospital stay. However, a subset of children experienced spontaneous VSD closure with delayed surgery. While both approaches led to comparable long-term cardiac function, early surgery appears to be the preferred option for reducing post-operative complications and enhancing recovery.
Keywords: Ventricular septal defect, congenital heart disease, early surgery, late surgery, pediatric cardiac surgery, post-operative outcomes