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[Long term follow-up of 799 children with isolated ventricular septal defects]
Sevcan Erdem1, Nazan Ozbarlas, Osman Küçükosmanoğlu
1Department of Pediatric Cardiology, Çukurova University, Adana, Turkey. serdem@cu.edu.tr
Insights
Pediatric ventricular septal defects (VSDs) show varying spontaneous closure rates based on type. Perimembranous VSDs are more likely to require surgical intervention, with potential complications noted post-surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Context:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities in children.
- Understanding the natural history and long-term outcomes of VSDs is crucial for effective management.
- This study focuses on isolated VSDs, excluding those with other cardiac anomalies.
Purpose:
- To evaluate the long-term follow-up results and prognosis of pediatric patients diagnosed with isolated ventricular septal defects (VSDs).
- To analyze spontaneous closure rates and identify factors influencing VSD resolution.
- To document the incidence of complications and outcomes following surgical intervention.
Summary:
- A cohort of 799 pediatric patients with isolated VSDs was followed for a mean of 32.8 months.
- Spontaneous closure rates varied by VSD type: muscular (42.7%), perimembranous (13.1%), and multiple (25%).
- Perimembranous VSDs were most frequently surgically closed (91.4% of surgical cases), with noted complications like aortic regurgitation post-surgery.
Impact:
- Provides valuable data on the natural course of isolated VSDs in a large pediatric cohort.
- Informs clinical decision-making regarding monitoring, intervention timing, and surgical approaches for VSDs.
- Highlights the importance of considering VSD type and patient age in predicting outcomes and potential complications.
Objectives:
We evaluated long-term follow-up results and prognosis of pediatric patients with isolated ventricular septal defects (VSD).
Study Design:
The study included 799 patients (368 girls, 431 boys; mean age at diagnosis 24.3±37.4 months; median 6 months) who were monitored by the pediatric cardiology department for VSD. The mean follow-up period was 32.8±30.3 months (median 20 months).
Results:
The VSDs were classified as perimembranous (n=610, 76.4%), muscular (n=171, 21.4%), doubly committed subarterial (n=10, 1.3%), and multiple (n=8, 1%). Spontaneous closure rates were 42.7%, 13.1%, and 25% in muscular, perimembranous, and multiple VSDs, respectively, which corresponded to a mean age of 18.6±19.9 months (median 12 months) in muscular and 30.2±33.7 months (median 14.5 months) in perimembranous VSDs. Before 2 years of age, 78.1% of muscular and 58.6% of perimembranous VSDs underwent spontaneous closure. Of 256 defects (32%) that required surgical closure, 91.4% were of perimembranous location. The mean age at surgery was 38.8±49.1 months (median 11 months) for muscular, and 43.7±40.9 months (median 24 months) for perimembranous defects. During the follow-up period, the following complications were noted: aortic valve prolapse (0.7%), aortic regurgitation (0.6%), left ventricle-to-right atrium shunt (2.6%), subaortic ridge (3.7%), and infundibular stenosis (1.2%). Aortic regurgitation developed in eight patients (3.7%) after surgical closure.
Conclusion:
Our data on the natural course and prognosis of VSDs may be of relevance with respect to patients' age, defect type, and complications encountered in the follow-up period.
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