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Ventricular septal defect in the first year of life
1Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City 37614-0002.
Insights
Ventricular septal defect (VSD) affects 5.7 per 1,000 live births. Muscular VSDs show higher spontaneous closure rates and better prognoses compared to perimembranous VSDs.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Neonatal Health
Background:
- Ventricular septal defect (VSD) is a common congenital heart lesion.
- Understanding the incidence and outcomes of different VSD types is crucial for clinical management.
- Previous studies have varied in their reporting of VSD incidence and spontaneous closure rates.
Purpose of the Study:
- To determine the incidence of ventricular septal defect (VSD) in a specific region.
- To compare the spontaneous closure rates, clinical outcomes, and need for surgery between muscular and perimembranous VSD types.
- To evaluate the role of Doppler color flow mapping in VSD diagnosis.
Main Methods:
- A retrospective study of approximately 22,000 live births over 4 years.
- Identification of 124 infants with VSD as the primary or isolated lesion, followed for at least 1 year.
- Utilized Doppler color flow mapping for diagnosis in 93 patients, categorizing VSDs into muscular and perimembranous types.
Main Results:
- The incidence of VSD was 5.7 per 1,000 live births.
- Overall spontaneous closure rate by the first year was 34% (42% for muscular, 23% for perimembranous VSD).
- Congestive heart failure and surgical intervention were more frequent in perimembranous VSDs compared to muscular VSDs.
Conclusions:
- Muscular VSDs have a significantly better prognosis with higher spontaneous closure rates than perimembranous VSDs.
- Doppler color flow mapping is a valuable diagnostic tool for VSD and may contribute to increased reported incidence.
- Early identification and differentiation of VSD types are essential for appropriate patient management and improved outcomes.
Abstract:
Of approximately 22,000 live births in the region under study during the last 4 years, ventricular septal defect (VSD) was identified as the primary or isolated congenital heart lesion in 124 infants who were followed up from birth for a minimum of 1 year (incidence, 5.7 per 1,000 live births). Doppler color flow mapping was performed in 93 of 124 patients; 47 had a muscular VSD and 46 had a perimembranous VSD. Only 1 patient had 2 muscular VSDs. None had a subpulmonic type of defect. Of 124 patients, 14 were lost to follow-up. Spontaneous closure was seen in 18 patients (42%) in the muscular group, in 9 (23%) in the perimembranous group and in 10 patients (37%) in the unclassified group by the end of the first year. The overall rate of spontaneous closure was 34% by the end of the first year. Congestive heart failure developed in 2 of 46 patients with muscular VSD and in 12 of 47 patients with perimembranous VSD. In the first year, 2 patients with muscular VSD as opposed to 5 with perimembranous VSD required surgery. Doppler color flow mapping is a valuable aid in the diagnosis of VSD and may be one reason for the observed increase in the incidence of VSD. The overall prognosis appeared much better in the muscular than the perimembranous type of VSD.