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Published on: February 8, 2022
Closure of ventricular septal defects: a study of factors influencing spontaneous and surgical closure
Stephen W Turner1, Tim Hornung, Stewart Hunter
1Department of Paediatric Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK.
Insights
Most ventricular septal defects (VSDs) in children close spontaneously. Defect size and morphology predict closure, not early age at diagnosis. Routine screening or surgical closure of asymptomatic VSDs is not supported.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Uncertainties persist regarding optimal VSD management, including screening and indications for closure.
Purpose of the Study:
- To investigate the natural history of clinically significant isolated VSDs in children.
- To evaluate factors influencing spontaneous closure and the need for surgical intervention.
Main Methods:
- Prospective study of a regional cohort of children with isolated VSDs.
- Data collected included defect characteristics, age at presentation and closure, and closure method.
- Follow-up averaged 65 months.
Main Results:
- Of 290 children, 54% had spontaneous VSD closure; 14% required surgical closure.
- Defect size and morphology were significant predictors of spontaneous and surgical closure.
- Young age at diagnosis predicted spontaneous closure but not the need for surgery.
Conclusions:
- VSD size and morphology are key determinants of natural closure and surgical necessity.
- Early age at presentation does not predict the need for surgical intervention.
- Findings do not support population screening or surgical closure of asymptomatic childhood VSDs.
Introduction:
Aspects of the management of ventricular septal defects which remain uncertain include the role of screening, and the need for closure of defects that remain patent.
Aim:
To ascertain the natural history of clinically significant ventricular septal defects, and to examine uncertainties in strategies of management.
Methods:
We studied prospectively a regional cohort of children born with isolated ventricular septal defects, noting age at presentation; sex; morphology and size of the defect; age at closure, if it occurred, and the means of closure.
Results:
We identified 290 children with isolated ventricular septal defects, of whom 147 (51%) were male. The mean follow up period was 65 months, with five cases being lost to follow up. Surgical closure was required in 41 (14%) cases, and 155 (54%) defects closed spontaneously. Spontaneous closure occurred in 123 (68%) out of 180 cases with completely muscular borders, and in 31 (29%) of the 107 patients with perimembranous defects. There were two cases with associated aortic regurgitation and no cases of endocarditis. Size and morphology of the defect were significant predictors of spontaneous and surgical closure. In addition, young age at diagnosis was a significant predictor of spontaneous closure.
Conclusions:
The size and morphology of a ventricular septal defect are important determinants of spontaneous closure and to the need for surgical intervention. Early age at presentation, in contrast, is not predictive of the need for surgical intervention. In early childhood, there appears to be very little risk of endocarditis or aortic valvar prolapse. Neither screening of populations to identify ventricular septal defects, nor surgical closure of asymptomatic defects in childhood, are supported by our findings.
