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Determinants of growth in patients with ventricular septal defect

R J Levy, A Rosenthal, O S Miettinen

    Circulation
    |April 1, 1978
    PubMed

    Insights

    Growth in children with ventricular septal defects (VSD) is often subnormal, influenced by factors beyond postnatal hemodynamics. Successful surgical repair improves weight but not height, indicating complex growth determinants.

    Area of Science:

    • Pediatric Cardiology
    • Congenital Heart Disease Research
    • Growth and Development Studies

    Background:

    • Ventricular septal defects (VSD) are common congenital heart conditions associated with impaired growth.
    • Understanding the multifactorial nature of growth disturbances in VSD is crucial for effective management.

    Purpose of the Study:

    • To investigate growth status in a large cohort of patients with VSD.
    • To identify factors influencing growth before and after intervention.
    • To elucidate the relationship between hemodynamics and growth in VSD.

    Main Methods:

    • Retrospective analysis of 1210 patients with VSD from the Joint Study on the Natural History of Congenital Heart Defects.
    • Comparison of growth parameters (height, weight) between medically managed and surgically repaired groups.
    • Multivariate analysis to determine predictors of admission height and weight.

    Main Results:

    • Patients with VSD exhibited subnormal height and weight at admission, correlated with physiological severity and age.
    • Successful surgical repair led to significant weight gain but not height improvement.
    • Medical management showed minimal impact on subnormal growth patterns.
    • Key determinants for admission height and weight included extracardiac anomalies, low birthweight, older admission age, heart failure history, and altered pulmonary/systemic pressure and flow ratios.

    Conclusions:

    • Severe growth disturbances in VSD are not solely due to postnatal hemodynamic alterations.
    • Intrauterine factors, genetics, and low birthweight significantly contribute to impaired growth.
    • These factors help explain the limited growth recovery observed even after successful VSD repair.

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