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The natural history of ventricular septal defects
S W Turner1, S Hunter, J P Wyllie
1Department of Paediatrics, South Cleveland Hospital, Marton Road, Middlesbrough TS4 3BW, UK.
Insights
Ventricular septal defects (VSDs) in children show varying closure rates based on position. Muscular VSDs have a higher spontaneous closure rate than perimembranous VSDs over six years.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Understanding factors influencing spontaneous closure is crucial for management.
- Long-term follow-up data on VSD closure rates are essential.
Purpose of the Study:
- To correlate VSD size and position with spontaneous closure rates in children.
- To analyze the natural history of isolated VSDs over a mean follow-up of six years.
- To identify predictors of VSD closure in a pediatric cohort.
Main Methods:
- Retrospective analysis of a birth cohort from a regional cardiac database.
- Inclusion of data on VSD size, position, and closure status.
- Mean follow-up duration exceeding six years for all patients.
Main Results:
- 68 children with isolated VSDs were analyzed.
- Spontaneous closure occurred in 35 defects, while 13 required surgical intervention.
- Muscular VSDs demonstrated a significantly higher spontaneous closure rate than perimembranous VSDs.
- Nine small muscular and five small perimembranous VSDs remained open after follow-up.
Conclusions:
- VSD position is a critical determinant of its natural history and closure potential.
- Perimembranous VSDs were more frequently associated with moderate/large defects requiring surgery.
- Over six years, approximately one-third of perimembranous and over two-thirds of muscular VSDs closed spontaneously.
Aims:
To correlate the size and position of isolated ventricular septal defects with closure rate in a cohort of children with mean follow up of more than six years.
Design:
A birth cohort was identified using the northern region cardiac database. The following were noted from case notes: defect size, position, means of closure, and age at closure.
Results:
68 children were identified. 49 defects were small, 14 were moderate, and 5 were large. 13 cases required surgical closure, including 12 perimembranous defects. 35 defects closed spontaneously. Nine of the small muscular defects remained open and five of the small perimembranous defects remained open. The spontaneous closure rate for muscular defects was significantly greater than for perimembranous defects. Mean age of follow up for patients who still have defects is 76 months.
Conclusions:
The position of a ventricular septal defect is extremely relevant to its natural history. Perimembranous defects accounted for most of the moderate and large defects that required surgical intervention. After more than six years almost a third of all perimembranous and just over two thirds of all muscular defects closed spontaneously.