Related Experiment Videos
Morphological, haemodynamic, and clinical variables as predictors for management of isolated ventricular septal
F van den Heuvel1, T Timmers, J Hess
1Division of Paediatric Cardiology, Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Predicting outcomes for isolated ventricular septal defect (VSD) is crucial. VSD morphology significantly impacts spontaneous closure, guiding management decisions for pediatric patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Isolated ventricular septal defect (VSD) is a common congenital heart anomaly.
- Management strategies vary, necessitating predictive tools for optimal patient care.
Purpose of the Study:
- To evaluate the predictive value of morphological, hemodynamic, and clinical factors in managing isolated VSD.
- To identify key indicators for surgical intervention versus conservative management.
Main Methods:
- Retrospective analysis of 263 pediatric patients with isolated VSD.
- Echocardiographic assessment of VSD morphology and hemodynamic characteristics.
- Inclusion of variables related to diuretic use, growth, and growth delay.
Main Results:
- VSD morphology significantly influenced spontaneous closure probability (P < 0.001).
- Surgically treated patients had non-restrictive defects and underwent early intervention.
- Growth delay was more pronounced in surgically treated patients.
Conclusions:
- Early surgical closure is recommended for non-restrictive VSD with severe growth delay.
- Conservative management is suitable for other cases, with morphology predicting closure likelihood.
- VSD morphology is a key determinant for estimating spontaneous closure timelines.
Objective:
To assess the predictive impact of morphological, haemodynamic, and clinical variables in the management of patients with isolated ventricular septal defect.
Design:
Retrospective analysis of variables by a sophisticated database management system.
Patients And Methods:
263 consecutive patients with isolated ventricular septal defect diagnosed by echocardiography. The morphological type and haemodynamic character of the ventricular septal defect was characterised in each patient. In addition, variables were introduced to represent the need for diuretics, growth, and potential delay in growth. In 43 patients (16.3%) the ventricular septal defect was closed surgically; 220 patients (83.7%) were managed conservatively and spontaneous closure of the ventricular septal defect occurred in 65 (29.5%). There were no deaths.
Results:
All patients managed surgically had non-restrictive defects and were operated on during the first year of life. A few patients with non-restrictive defects were managed conservatively. The two groups differed significantly only with respect to mean growth delay (0.65 (0.27) v 0.9 (0.21), P < 0.001). Only the morphology of the ventricular septal defect significantly (P < 0.001) influenced the probability of closure.
Conclusions:
Findings imply that early surgical closure of ventricular septal defect is indicated in patients with non-restrictive ventricular septal defect and severe growth delay. Other patients should be managed conservatively. In these patients the morphological type of the defect determines the probability of spontaneous closure and provides an estimate of the period over which decreased in size or closure can be expected.