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Importance of spontaneous closure of the ventricular part in atrioventricular septal defect
1Department of Pediatrics, Veterans General Hospital, Taipei, Taiwan, Republic of China.
Insights
Children with atrioventricular septal defects that close spontaneously have milder symptoms and better outcomes. Early closure of the ventricular defect in these children indicates a more favorable prognosis.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Atrioventricular septal defects (AVSD) are congenital heart abnormalities.
- Understanding the natural history and prognostic factors of AVSD is crucial for clinical management.
Purpose of the Study:
- To investigate the clinical features, hemodynamic changes, and prognosis of children with simple atrioventricular septal defects.
- To compare outcomes between patients with spontaneous closure of the ventricular septal defect and those without.
Main Methods:
- A retrospective study of 21 children with simple AVSD over a median follow-up of 3 years.
- Group I: 6 patients with spontaneous closure of the ventricular defect.
- Group II: Patients without spontaneous closure, compared for clinical, hemodynamic, and survival data.
Main Results:
- Spontaneous closure of the ventricular defect occurred in 6 patients (Group I).
- Group II patients exhibited more severe symptoms (failure to thrive, infections, heart failure) and higher hemodynamic derangements (Qp/Qs, pulmonary vascular resistance).
- Group II had significantly higher preoperative mortality rates and a higher incidence of postoperative complications.
Conclusions:
- Spontaneous closure of the ventricular part of an AVSD is associated with less severe clinical manifestations.
- Children with spontaneous closure demonstrate a significantly better prognosis compared to those without closure.
- Early identification of spontaneous closure can guide clinical expectations and management strategies for AVSD.
Abstract:
The clinical features, hemodynamic changes and prognosis of 21 children with simple atrioventricular septal defect (3 associated with patent ductus arteriosus) were studied during a follow-up period of 1 month to 13 3/12 years (median 3 years). Six patients had spontaneous closure of the ventricular part of the defect within 22.2 +/- 27.7 months (Group I). The symptoms and signs of failure to thrive, frequent respiratory tract infections and congestive heart failure were more common in patients without spontaneous closure of the ventricular part of atrioventricular septal defect (Group II) than in patients in Group I. The Qp/Qs ratio, pulmonary vascular resistance and pulmonary to systemic resistance ratio were also higher in Group II than in Group I. In spite of a higher postoperative mortality rate and a higher incidence of transient complete heart block, the children in Group II also had a significantly higher (p less than 0.005) preoperative mortality rate than those in Group I. In conclusion, if the ventricular part of the atrioventricular septal defect closed or was closing spontaneously, symptoms and signs were less severe and there was a better prognosis.