Pattern of ventricular septal defects and associated complications

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Echocardiography

Background:

• Ventricular Septal Defect (VSD) is a common congenital heart anomaly.
• Understanding the prevalence and types of VSD is crucial for effective management.
• Complications associated with different VSD types require careful evaluation.

Purpose of the Study:

• To determine the frequency of various Ventricular Septal Defect (VSD) types in a local pediatric population.
• To identify and analyze the complications associated with different VSD subtypes.
• To provide data relevant to the management of VSDs in Pakistan.

Main Methods:

• A case series study was conducted at a Paediatric Cardiac Unit in Lahore.
• 854 pediatric patients (1 day to 18 years) with isolated VSD were evaluated.
• Transthoracic echocardiography (2-D, continuous wave Doppler, color Doppler) was the primary diagnostic tool, supplemented by transesophageal echocardiography and angiography when needed.

Main Results:

• Perimembranous VSD was the most frequent type (83.1%), followed by muscular (11.7%), doubly committed subarterial (DCSA) (2.9%), and inlet VSD (2.2%).
• Aortic Valve Prolapse (AVP) occurred in 10.8% of patients, with 47.3% experiencing aortic regurgitation (AR).
• AVP and AR were predominantly associated with perimembranous outlet VSDs, not DCSA VSDs. Four patients had right ventricular outflow tract obstruction, two with subacute bacterial endocarditis.

Conclusions:

• Perimembranous VSD is the most common type encountered in this Pakistani tertiary care setting.
• The high incidence of AVP and AR in perimembranous VSDs has significant clinical implications.
• These findings are particularly relevant in Pakistan due to a large number of unoperated VSD cases.