Related Experiment Videos
Clinical course of isolated ventricular septal defect: an Indian experience
A Saxena1, R Tandon, S Shrivastava
1Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi.
Insights
Isolated ventricular septal defect (VSD) often shows decreased shunt size, with spontaneous closure in some cases. Regular follow-up is crucial for managing VSD complications and preventing Eisenmenger
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Ventricular septal defect (VSD) is a common congenital heart anomaly.
- Understanding the natural clinical course of isolated VSD is essential for patient management.
Purpose of the Study:
- To define the long-term clinical course of isolated ventricular septal defect.
- To identify the incidence of spontaneous closure and associated complications.
Main Methods:
- A retrospective study of 410 consecutive patients with isolated VSD.
- Evaluation over a 13-year period with a minimum 2-year follow-up.
- Analysis of shunt size changes, development of complications, and outcomes.
Main Results:
- The left-to-right shunt size remained stable in 52.4% of patients.
- Shunt size decreased in 34.4%, with 8.8% experiencing spontaneous VSD closure.
- Complications included right ventricular outflow tract obstruction (8.5%), aortic regurgitation (8.9%), infective endocarditis (6 cases), and Eisenmenger's complex (3 cases).
Conclusions:
- A significant proportion of isolated VSDs show a decrease in shunt size or spontaneous closure.
- Regular patient follow-up is critical for early detection and management of potential complications.
- Proactive monitoring can help prevent severe outcomes like Eisenmenger's complex.
Abstract:
To define the clinical course of ventricular septal defect, 410 consecutive patients with isolated ventricular septal defect were evaluated over a period of 13 years. Their age ranged from 12 days to 24 years at the time of first visit to the hospital. Patients with less than 2 years follow-up period were excluded. One hundred and fifty seven patients were one year of age or less. The left to right shunt size remained the same in 52.4% of cases. In 34.4% the shunt size decreased, with complete closure of ventricular septal defect in 8.8%. Closure of ventricular septal defect was observed even in patients who had initially presented with large left to right flow, and congestive heart failure in infancy. Right ventricular outflow tract obstruction developed in 8.5% of patients usually between 2 and 10 years of age. Murmur of aortic regurgitation appeared in 8.9% on follow-up. Infective endocarditis developed in 6 cases. The unfortunate complication of Eisemenger's complex was seen in 3 patients; they had not returned for follow up for a long period of time. Hence, our data show that the left to right shunt across the ventricular septal defect decreases in about one-third of patients. However, a regular follow up is essential to prevent development of Eisenmenger's complex and for early detection of other complications like aortic regurgitation and right ventricular outflow tract obstruction.