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[Clinical study of membranous ventricular septal defect in infancy and childhood by two-dimensional echocardiography]
Insights
Pouch formation of the septal leaflet (PSL) and membranous septal aneurysm (MSA) in ventricular septal defect (VSD) patients can predict spontaneous closure and better outcomes. Two-dimensional echocardiography (2DE) is crucial for identifying these features and guiding management.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Imaging
Context:
- Isolated ventricular septal defect (VSD) is a common congenital heart condition.
- Membranous VSD requires accurate diagnosis and prognosis assessment.
- Two-dimensional echocardiography (2DE) is a key imaging modality in VSD evaluation.
Purpose:
- To investigate the role of pouch formation of the septal leaflet (PSL) and membranous septal aneurysm (MSA) in isolated membranous VSD.
- To assess the predictive value of 2DE findings (PSL, MSA) for VSD closure and pulmonary hypertension.
- To evaluate the clinical utility of 2DE in managing pediatric VSD patients.
Summary:
- A study involving 48 patients with membranous VSD utilized 2DE to identify PSL and MSA.
- Patients with PSL and MSA showed lower pulmonary artery pressure and smaller shunts, correlating with spontaneous closure.
- Absence of PSL and MSA was associated with pulmonary hypertension and less favorable prognosis.
Impact:
- PSL and MSA identified via 2DE are significant indicators for spontaneous VSD closure and improved prognosis.
- 2DE visualization of PSL and MSA aids in predicting outcomes and clinical management of VSD.
- This research highlights the importance of specific echocardiographic findings in VSD patient care.
Abstract:
A two-dimensional echocardiographic study was performed in patients (pts) with isolated ventricular septal defect (VSD). Group I included 48 pts with membranous VSD (aged from 3 months to 11 years) diagnosed by cardiac catheterization and angiocardiography. In 25 of 27 pts demonstrated a defect only by two-dimensional echocardiography (2DE), mean pulmonary artery pressure (MPAP) was higher than 25 mmHg and 26 of these 27 pts showed a large left to right shunt of more than 30 per cent, and the remaining one pt had Eisenmenger complex. In 15 of 16 pts demonstrated VSD with the pouch formation of the septal leaflet (PSL) by 2DE, MPAP was lower than 25 mmHg. These 16 pts showed various left to right shunt ratios (small to large). In all 4 pts demonstrated VSD with membranous septal aneurysm (MSA) and 1 pt demonstrated no findings by 2DE, MPAP was low (under 25 mmHg) and a left to right shunt was small. Group II included 400 pts with membranous VSD (aged 11 days to 15 years) diagnosed clinically. All 221 pts demonstrated VSD had PSL or MSA. PSL was demonstrated in 261 pts, MSA in 27 pts, both PSL and MSA in 33 pts and no findings in 79 pts by 2DE. Group III included 41 pts with spontaneous closed VSD (aged 3 months to 8 years) diagnosed clinically. PSL was demonstrated in 15 pts, MSA in 11 pts and no findings in 15 pts by 2DE. On the basis of these observation, PSL and MSA may play an important role in spontaneous diminution or closure of membranous VSD, and in most of VSD pts without PSL and MSA pulmonary hypertension is shown and spontaneous diminution of VSD size can not be anticipated. Visualization of PSL and MSA by 2DE may predict the prognosis and is clinically very useful in the management of pts with isolated membranous VSD.