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Regression of right ventricular pressure in ventricular septal defect in infancy: a longitudinal color-flow Doppler
1Department of Pediatric Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Turkey.
Insights
Right ventricular pressure (RVP) in infants with ventricular septal defect (VSD) decreases over time, particularly with smaller defects. Defect size significantly influences RVP normalization and spontaneous closure rates.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Isolated ventricular septal defect (VSD) is a common congenital heart anomaly.
- Understanding the natural history of right ventricular pressure (RVP) in VSD is crucial for management.
- Factors influencing RVP progression in infants with VSD require further elucidation.
Purpose of the Study:
- To investigate the longitudinal course of right ventricular pressure (RVP) in infants with isolated VSD.
- To identify factors, particularly VSD size, that influence RVP changes over time.
- To assess the correlation between VSD size and clinical outcomes such as spontaneous closure and heart failure.
Main Methods:
- Longitudinal follow-up of 148 infants with isolated VSD using color-Doppler echocardiography.
- Patients categorized into three groups based on VSD size (4 to 7 mm).
- RVP estimated using Doppler, analyzing temporal changes and correlating with VSD size and defect type.
Main Results:
- Initial RVP correlated positively with VSD size, ranging from 15 to 95 mmHg.
- RVP generally decreased over time, with a faster rate in smaller defects (Group I).
- Spontaneous VSD closure occurred in 51% of Group I, 10% of Group II, and 0% of Group III. Congestive heart failure and mortality were higher in larger VSD groups.
Conclusions:
- VSD size is a primary determinant of RVP course and clinical outcomes in infants.
- A regression equation can predict RVP temporal changes based on initial VSD size.
- Early identification and monitoring of VSD size are essential for predicting RVP normalization and prognosis.
Abstract:
To determine the course of right ventricular pressure (RVP) in patients with isolated ventricular septal defect (VSD) and factors influencing it, unselected 148 infants were followed-up longitudinally with color-Doppler echocardiography from a median age of 1 month for 201 patient-years. The patients were divided into three groups by absolute echographic size of VSD: group I, 4 to 7 mm. Sixty percent belonged to group I. Muscular defects dominated in group I, perimembranous defects dominated in group II, and those with outlet extensions dominated in group III. Peak systolic RVP was obtained by Doppler-estimated difference between systolic brachial artery and peak gradient across the VSD. Initial RVP ranged between 15 and 95 mmHg and increased in parallel to the size of defect. According to the regression equations RVP decreased in general by 0.17 mmHg per month. This correlated significantly with the size of the defect. In group I, the rate of decrease was very fast and is best expressed by a log function of time (r = -0.67, r(2) = 0.45). In groups II and III the rate of decrease was less steep and had a greater variability. RVP normalized in 100% in those of group I and in 90% of group II, at median ages of 0.17 and 0.33 years, respectively. Median Q(p):Q(s) values were 1.5, 2.2, and 3.0 in groups I-III, respectively. The outcome depended on the size of VSD. Spontaneous closure was observed in 51% of group I, 10% of group II, and none of group III. The rate was higher in muscular defects. Congestive heart failure was present in 53% and 100% in groups II and III, respectively. Death rate was 2.03%, all in patients with large defects. It is concluded that the temporal course of RVP with time can be estimated fairly well by the regression equation presented in relation to the initial size of the VSD.