SPONTANEOUS CLOSURE OF ISOLATED VENTRICULAR SEPTAL DEFECT IN THE FIRST FIVE YEARS OF LIFE
Tishk M Salam *, Aso F Salih ** and Jamal A Rashid **
* Sulaimani Pediatric Teaching Hospital, Sulaimani Directorate of Health.
** Department of Peidatrics, School of Medicine, Faculty of Medical sciences, University of Sulaimani.
Submitted: 17/12/2012; Accepted: 11/6/2013; Published 1/12/2013
DOI Link: https://doi.org/10.17656/jsmc.10037
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.
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.
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.
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.
Ventricular septal defect, Spontaneous closure, Perimembranous.
1- Congenital cardiovascular defects by McDaniel N.L, Gutgesell H.P.; in Moss and Adams’ Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adults, Hugh D. Allen, Howard P. Gutgesell, Edward B. Clark, David J. Driscoll , 7th Ed,2008: 669-681.
2- Ventricular septal defect by Daniel B., in Nelson Textbook of Pediatrics , Kligman, Behrman, Stanton, ST.Geme, Schor , 19th Ed, 2011: 1556-1559.
3- Ramaciotti C, Keren A, Silverman NH. Importance of perimembranous ventricular septal aneurysm in the natural history of isolated perimembranous ventricular septal defect. Am J Cardiol 1986; 57:268.
4- Anderson RH, Lenox CC, Zuberbuhler JR. Mechanisms of closure of perimembranous ventricular septal defect. Am J Cardiol 1983; 52:341.
5- Soto B, Becker AE, Moulaert AJ, Lie JT, Anderson RH . Classification of ventricular septal defects. Br Heart J 1980; 43:332.
6- Ando M, Takao A. Pathological anatomy of ventricular septal defect associated with aortic valve prolapse and regurgitation. Heart Vessels 1986; 2:117.
7- Roguin N, Du ZD, Barak M, et al. High prevalence of muscular ventricular septal defect in neonates. J Am Coll Cardiol 1995; 26:1545.
8- Du ZD, Roguin N, Barak M, Bihari SG, Ben-Elisha M. spontaneous closure of muscular ventricular septal defect identified by echocardiography in neonates. Cardiol Young1998; 8: 500-505.
9- Shirali GS, O’Brian Smith E, Geva T. Quantitation of echocardiographic predictors of outcome in infants with isolated ventricular septal defect. Am Heart J(1995) 130:1228–1235
10. SW Turner, S Hunter, J P Wyllie. The natural history of ventricular septal defects. Arch Dis Child 1999; 81:413-416
11- Bramendi CJR,Pastor ME,Galdeano JM. Interventricular communication in the neonatal period.An Esp Pediatr 1998; 49 :284-288
12- Mehta AV, Chidambaram B. Ventricular septal defect in the first year of life. Am J Cardiol. 1992; 70: 364-6.
13- Miyake T, Shinohara T, Nakamura Y, Fukuda T, Tasato H, Toyohara K, et al. Spontaneous closure of ventricular septal defects followed up from < 3 months of age. Pediatr Int. 2004; 46: 135-40.
14- Moe DG, Guntheroth WG. Spontaneous closure of uncomplicated ventricular septal defect. Am J Cardiol. 1987; 60: 674-8.
15- Lin MH, Wang NK, Hung KL, Shen CT. Spontaneous closure of ventricular septal defects in the first year of life. J Formos Med Assoc. 2001; 100: 539-42.
16- Sands A, Lynch C, Casey F, Craig B, Dornan J, Mulholland C Ventricular septal defects; the relationship of social class and area of residence to occurrence rate. Fetal Diagn Ther .1998;13 (suppl I) 148.
17-Hiraishi S, Agata Y, Nowatari M, Oguchi K, Misawa H, Hirota H, et al. Incidence and natural course of trabecular ventricular septal defect; two dimensional echocardiography and color doppler flow imaging study. J Pediatr .1992; 120:409–415.
18- Atik's E. Small ventricular septal defect: long-term expectant clinical management. Arquivos Brasileiros de cardiologia. 2009; 92(6):429-32
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.