Related Experiment Videos
Increased prevalence of ventricular septal defect: epidemic or improved diagnosis
G R Martin1, L W Perry, C Ferencz
1Department of Pediatric Cardiology, George Washington University, Washington, DC.
Insights
An increase in infant ventricular septal defects was observed, but this rise in congenital heart defects is attributed to improved echocardiography detection, not an epidemic. Early diagnosis of isolated defects has increased.
Area of Science:
- Pediatric Cardiology
- Epidemiology
- Medical Diagnostics
Background:
- The Baltimore-Washington Infant Study monitors congenital cardiovascular malformations.
- An increase in ventricular septal defects (VSDs) was noted between 1981 and 1984.
Purpose of the Study:
- To investigate the rise in VSD prevalence among infants.
- To determine if the increase in congenital heart defects signifies an epidemic.
Main Methods:
- A case-control study analyzing data from 1,494 infants with confirmed diagnoses.
- Diagnoses confirmed via echocardiography, catheterization, surgery, or autopsy.
- Prevalence rates per 1,000 live births were calculated and compared over time.
Main Results:
- Overall congenital cardiovascular malformations increased from 3.6 to 4.5 per 1,000 live births (P < .025).
- VSD prevalence rose from 1.0 to 1.6 per 1,000 live births (P < .001), accounting for the total increase.
- Isolated VSD prevalence increased significantly (0.67 to 1.17 per 1,000 live births, P < .001).
- No change in VSD with specific co-occurring conditions; no change in VSDs diagnosed via catheterization, surgery, or autopsy.
- VSDs diagnosed by echocardiography increased from 0.30 to 0.70 per 1,000 live births (P < .001).
Conclusions:
- The reported increase in VSD prevalence is primarily due to enhanced detection of small, isolated defects using echocardiography.
- There is no evidence to support an epidemic of congenital heart defects.
- Improved diagnostic capabilities, particularly echocardiography, are key to understanding changing prevalence rates.
Abstract:
The Baltimore-Washington Infant Study is an ongoing case-control study of congenital cardiovascular malformations in infants in whom the clinical diagnoses have been confirmed by echocardiography, catheterization, surgery, or autopsy. An increase in the prevalence of ventricular septal defects was detected in 1,494 infants with congenital cardiovascular malformations between 1981 and 1984. The prevalence of congenital cardiovascular malformations increased from 3.6 to 4.5 per 1,000 live births (P less than .025) and the prevalence of ventricular septal defect increased from 1.0 to 1.6 per 1,000 live births (P less than .001). The increase in ventricular septal defects accounted for the total increase in congenital cardiovascular malformations. The prevalence of isolated ventricular septal defect increased from 0.67 to 1.17 per 1,000 live births (P less than .001). The prevalence of ventricular septal defect with associated coarctation of the aorta, patent ductus arteriosus, atrial septal defect, and pulmonic stenosis did not change. The prevalence of ventricular septal defect diagnosed by catheterization, surgery, and autopsy did not change; however, defects diagnosed by echocardiography increased from 0.30 to 0.70 per 1,000 live births (P less than .001). It is concluded that the reported increase in prevalence of ventricular septal defect is due to improved detection of small, isolated ventricular septal defects and that there is no evidence of an "epidemic."