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Updated: Aug 3, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Twenty-five-year experience with ventricular septal defect in infants and children
Insights
Small and moderate ventricular septal defects (VSDs) in children often resolve without surgery. Large VSDs may require intervention, but many close spontaneously, indicating a good prognosis with proper management.
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.
Abstract:
Three hundred eighty-one children with isolated VSD were catheterized from 1960 through 1985, 228 of whom were first catheterized in the first year of life. Defect size was defined by the right-to-left ventricular systolic pressure ratio. Patients with small VSD had a good outcome, with no pulmonary vascular disease. Seventy-five percent of patients with moderate VSDs did not require surgery, and 58% had normal pulmonary artery pressures documented on a second catheterization. Of those patients with large VSDs who underwent serial catheterizations in the first year of life before surgery, 62% had partial closure, and pulmonary vascular resistance rose in 21%. None developed pulmonary vascular disease after surgery. Fewer large-restrictive than nonrestrictive VSDs required surgery in infancy (12% vs 51%; p less than 0.005), and more closed enough to never require surgery (62% vs 27%; p less than 0.005, chi square). Surgery is rarely necessary for patients with small and moderate-sized VSDs in the first year and is usually never necessary because of the expected decrease in size. Few patients with large-restrictive VSDs have an increase in pulmonary vascular resistance, many defects decrease in size, and most patients never need surgery. Patients who have a nonrestrictive VSD have an excellent prognosis with appropriate management.
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