Twenty-five-year experience with ventricular septal defect in infants and children

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Ventricular Septal Defects (VSDs) are common congenital heart abnormalities.
• Understanding VSD natural history is crucial for appropriate management.

Purpose of the Study:

• To analyze the long-term outcomes of isolated VSDs based on defect size.
• To evaluate the need for surgical intervention in different VSD categories.

Main Methods:

• Retrospective analysis of 381 children with isolated VSDs catheterized between 1960-1985.
• Defect size categorized by right-to-left ventricular systolic pressure ratio.
• Serial catheterizations used to assess VSD progression and pulmonary artery pressures.

Main Results:

• Small VSDs generally had good outcomes without pulmonary vascular disease.
• 75% of moderate VSDs did not require surgery; 58% showed normal pulmonary artery pressures on follow-up.
• Large-restrictive VSDs were less likely to require surgery in infancy compared to nonrestrictive VSDs (12% vs 51%).
• Many VSDs, particularly large-restrictive types, demonstrated spontaneous closure or decrease in size.

Conclusions:

• Surgery is infrequently necessary for small and moderate VSDs in the first year of life due to spontaneous improvement.
• Large-restrictive VSDs often decrease in size, with many patients avoiding surgery.
• Nonrestrictive VSDs have an excellent prognosis with appropriate clinical management.