SPONTANEOUS CLOSURE OF ISOLATED VENTRICULAR SEPTAL DEFECT IN THE FIRST FIVE YEARS OF LIFE

Tishk M Salam*
Aso F Salih**
Jamal A Rashid***

* Sulaimani Pediatric Teaching Hospital, Sulaimani Directorate of Health.
** Department of Peidatrics, School of Medicine, Faculty of Medical sciences, University of Sulaimani
*** Department of Peidatrics, School of Medicine, Faculty of Medical sciences, University of Sulaimani.


SPONTANEOUS CLOSURE OF ISOLATED VENTRICULAR SEPTAL DEFECT IN THE FIRST FIVE YEARS OF LIFE


ABSTRACT


Background
Isolated VSD is the most common congenital heart defect. The defect can be in any portion in the septum and of different size that play an important role in the clinical outcomes of its spontaneous closure.

Objective
To correlate the size and location (excluding inlet type) of isolated VSD with spontaneous closure rate in the 1st 5 years of life.

Materials and Methods
This is a retrospective study for patient’s record with VSD that visited Sulaimani Pediatric Teaching Hospital during 1st of January 2006 to 30th of February 2011 in Echocardiography Unit observed and studied by the same operator. The data analysis of 87 children records with isolated VSD had been studied on frequent outpatient clinic visits and followed up for a maximum period of 5 years or until spontaneous closure had occurred. Results from two dimensional, and Doppler (spectral and color) echocardiography examinations were evaluated for each patient.

Results
The age range of patients at time of initial examination who received follow up was 5 days to 12 months old. Spontaneous closure occurred in 43(49.4%) of the 87 cases that were followed up for 5 years. Thirty six (62.1%) cases of small, 7 (35%) cases of moderate and none of the patients with large VSDs had spontaneous closure. Spontaneous closure was noted in 34 (72.3%) of 47 cases of muscular defects and in 9 (22.5%) of 40 patients with perimembranous VSD. The time of spontaneous closure ranged from 1 to 60 months and it occurred most commonly during the first 24 months of age. By the 1st, 2nd, 3rd and 4th year cumulative spontaneous closure occurred in 28.7%, 43.6%, 47.1%, and 48.2% respectively and at the 5th year it was seen in all 43 cases.

Conclusion
More than half of the small and one third of moderate size VSD had spontaneous closure by 5 year of age. Two thirds of muscular and nearby one fourth of perimembraneous defects have closed spontaneously.The majority of spontaneous closures occurred in the first 2 years of life.

Keywords: Ventricular septal defect, Spontaneous closure, Perimembranous.


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Kewan Omer,
Jan 22, 2015, 9:33 AM