The natural history of ventricular septal defects in infancy

Turkish Journal of Pediatrics

The aim of this study was to evaluate the incidence and spontaneous closure rate of ventricular septal defects in a randomly selected newborn population, using color flow Doppler echocardiographic screening. Color flow Doppler echocardiographic screening was performed in 1075 neonates within the first 72 hours of life. We also followed-up patients with ventricular septal defect for a year to detect spontaneous closure rate and its timing. The incidences of ventricular septal defect in all neonates, preterm neonates and term neonates were found as 47.4/1,000, 56/1,000 and 46.3/1,000 live births, respectively. All patients with ventricular septal defect except one were asymptomatic. Forty-six cases had a trabecular and five cases had perimembranous ventricular septal defect. With the exception of one case, all had a small ventricular septal defect (< or =3 mm). Spontaneous closure was observed in 88.6% of ventricular septal defects within the first year. Closure rate was found as 1...

Heart, 1981

We have reviewed data on all patients born between 1960 and 1969 and registered in the Liverpool Registry of Congenital Malformations as having congenital heart disease. There were 385 with a ventricular septal defect as their sole or main cardiac lesion. Analysis of the available follow-up data showed that 50 ofthese were subsequently assigned to other diagnostic categories and a further 41 failed to fulfil our diagnostic criteria for a ventricular septal defect, leaving 294 patients for study. In view of the high incidence of small defects in asymptomatic infants and children not subjected to cardiac catheterisation, clinical criteria for the acceptance of the diagnosis were defined and 190 patients were included on these grounds alone. The clinical course, associated cardiac and non-cardiac defects, and surgical implications were analysed. The majority of defects were small and 31% closed spontaneously. Fifty per cent ofthe deaths in infancy were unrelated to the ventricular septal defect. We estimate that by present criteria only 15% of an unselected population of patients with a ventricular septal defect are likely to require surgical treatment.

Zenodo (CERN European Organization for Nuclear Research), 2021

Background: Ventricular septal defects (VSDs) are still one of the most prevalent surgical indications in newborns and children with congenital heart disease. With advances in echocardiography, cardiac catheterization is no longer necessary in the treatment of these individuals. Although perioperative mortality and morbidity for isolated defects are still low, unique scenarios such as surgical care of numerous VSDs and decision-making in patients with pulmonary hypertension remain difficult. This chapter examines both classic and recent evidence that has shaped the management of this condition, as well as the facts underlying developing interventional methods utilized in both the catheterization lab and the operating room. Conclusion: VSD is the most common congenital abnormality at birth. Small flaws should close on their own within the first year of life; however, larger faults can cause serious difficulties. The major interventions for big problems are surgical VSD closure and device closure.

Circulation, 1968

It is difficult to make prognoses and decisions on therapy of individuals with congenital heart disease (CHD) and plan efficiently for medical services and training programs because studies on the incidence and relative frequency of different types of CHD at birth, mortality rates, times of death, and prevalence rates in children and adults are incomplete or unrepresentative. The present study assesses the merits of previous surveys and attempts to indicate the best information about these rates. Specific attention has been directed to data on ventricular septal defect (VSD), with an estimated incidence of at least 20/10,000 live births; about 10% of these children died before 15 years of age. There should thus be about 18/10,000 surviving school children with VSD, yet the most intensive school surveys show only about half this number. This supports the suggestion that there is a high incidence (perhaps 50%) of spontaneous closure of VSD during childhood. Spontaneous closure may also occur frequently after childhood, but this conclusion needs to be confirmed by better surveys.

Ultrasound in Obstetrics and Gynecology, 2000

Objective To characterize and describe the evolution of ventricular septal defects (VSD) from intra-uterine diagnosis to infancy in a population of fetuses with isolated defects.

Archives of disease in childhood, 2016

Ventricular septal defects (VSDs) are the most common congenital heart defects (CHDs). Previous studies indicate an increased risk of endocarditis, aortic regurgitation, left ventricular outflow tract obstructions, pulmonary hypertension, arrhythmias and sudden death in patients with isolated VSDs. The present nationwide cohort study reports mortality and cardiac complications requiring hospitalisation or intervention in children with isolated VSDs. Medical information concerning all 943 871 live births in Norway in 1994-2009 was retrieved from the Medical Birth Registry of Norway, the Cardiovascular Disease in Norway project, the Oslo University Hospital's Clinical Registry of Congenital Heart Defects and the Norwegian Cause of Death Registry. Isolated VSDs were identified in 3495 children without known chromosomal aberrations or extracardiac malformations. Surgical or catheter-based treatment of VSD was performed in 181 (5.2%) cases. Twelve (0.3%) children with VSDs died befor...

The American Journal of Cardiology, 2019

Although ventricular septal defect (VSD) is a common and simple congenital heart disease (CHD) in newborns, its true incidence and spontaneous closure (SC) rate remains topics of controversy. This study aims to provide data on the true incidence and SC rate of VSD in the Chinese neonatal population. We conducted a prospective study at three hospitals, all newborns underwent echocardiography. Those with a diagnosis of isolated VSD were included in the study group and underwent a 7-year follow-up period. Among 6750 newborns, VSDs were detected in 113 cases (incidence rate of 16.7‰), accounting for 62.8% of CHD, of which 35 were perimembranous (5.2‰), 72 were muscular (10.7‰), and 6 were doubly committed juxta-arterial (DCJA) (0.9‰). During the 7-year follow-up period, 18 cases required surgical or transcatheter closure. The SC rate among those with perimembranous VSD (pVSD) and muscular VSD (mVSD) were 51.4% (18/35) and 97.2% (70/72) respectively. Excluding DCJA, perimembranous site and defects ≥4mm are risk factors for VSD that do not spontaneously close. Independent predictive factors for pVSD which do not spontaneously close is defects ≥4mm. There was no significant difference in the SC rate at different times between the four mVSD sites. In conclusion, this study provides the true incidence and SC rate for Chinese newborns with VSD.

Journal of Evolution of Medical and Dental Sciences

BACKGROUND Ventricular Septal Defect (VSD) is the most common congenital heart disease in children. Our study was done with the aim to analyse the clinical profile and size and type of VSD in Paediatric patients admitted in a tertiary care hospital in Assam. METHOD This is a prospective cross-sectional study of 2 years' duration conducted in the Department of Paediatrics, Assam Medical College, Dibrugarh. Children aged 1 month to 12 years with a clinical diagnosis of VSD were evaluated by echocardiography to confirm the diagnosis. Only isolated VSD cases were enrolled in the study. Data was entered and analysed by SPSS version 16. RESULT Among the total of 70 cases, 47.1% were female and 52.9% were male; 54.3 % cases presented in infancy and 46 patients (65.7%) had their first symptom before one year. Perimembranous was the commonest (74.3%) followed by muscular (22.9%) and doubly committed subarterial (2.9%) VSD. Common symptoms were cough (68.6%), fever (68.6%), breathlessness (52.9%), feeding problem (45.7%), failure to thrive (45.7%) and fatigue (40%). Pansystolic murmur (100%), tachypnoea (62.9%), tachycardia (62.9%), crepitations (57.1%), subcostal retraction (45.7%), hepatomegaly (34.3%) and wheeze (20%) were the frequent clinical findings. Complications associated were pneumonia (57.1%), malnutrition (51.4%), congestive cardiac failure (CCF) (34.3%) and pulmonary hypertension (17.1%). CONCLUSION Perimembranous was the commonest type of VSD. Small VSD presented with mild symptoms or were asymptomatic. Moderate and large VSD presented with severe symptoms and complications. Clinical examination and diagnostic modalities like chest X-ray, ECG and echocardiography is helpful in diagnosing VSD. Early diagnosis and management will help in preventing the associated complications, thereby reducing the mortality and morbidity in these children.

Cardiovascular diseases, 1975

Objective: This study aimed to review a ten years experience of surgical closure of ventricular septal defect in infants, assessing the postoperative clinical and hemodynamic results. Patients and Methods: During the study period between Jan 1991 to Jan 2001,a total of 153 patients aged less than two years, underwent surgical closure of ventricular septal defect. Follow up evaluation include clinical symptoms, electrocardiogram, 2-dimensional echocardiography and cardiac catheterisation. The main indications for follow up cardiac catheterisation were: persistent respiratory symptoms, a clinical or echocardiography signs of residual leak across the VSD and improper weight gain. Results: Follow up was completed in 150 patients. Cardiac catheterisation was performed in 42 patients. 132 patients (88.0%) had complete resolution of their preoperative symptoms. Complete closure of the ventricular septum was achieved in 115 patients (76.6%). 28 patients (18.7%) had small residual leak across the septum, 6(4%) patients had significant leak across the septum and needed a second operation to close the defect, and five patients (3.3%) had small leak and mild pulmonary hypertension, but the calculated left to right shunt was <1.5:1 and they needed medical treatment for one year. Persistent severe pulmonary hypertension was noticed in one patient who underwent atrial septostomy. The mean pulmonary arterial pressure dropped from 60 mmHg to 27 mmHg. Three patients (2.0%) had complete heart block and needed an insertion of permanent pacemaker. The hospital mortality of the entire group was 1.30 % and there was no late mortality. Conclusion: Surgical closure of ventricular septal defects at an early age resulted in resolution of symptoms, satisfactory 2-dimensional echocardiography and Doppler findings and further reduction in pulmonary artery pressure as early as three months in most patients.