Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-26T17:04:22.607Z Has data issue: false hasContentIssue false
  • English
  • Français

Closure of ventricular septal defects: a study of factors influencing spontaneous and surgical closure

Published online by Cambridge University Press:  30 July 2009

Stephen W. Turner ,
Tim Hornung  and
Stewart Hunter
Stephen W. Turner
Affiliation:
Department of Paediatric Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
Tim Hornung
Affiliation:
Department of Paediatric Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
Stewart Hunter*
Affiliation:
Department of Paediatric Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
*
Consultant in Paediatric Cardiology, Freeman Hospital, High Heaton, Newcastle-upon-Tyne NE7 7DN, UK. Tel: 0191 284 3111; Fax: 0191 213 2167; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: Aspects of the management of ventricular septal defects which remain uncertain include the role of screening, and the need for closure of defects that remain patent. Aim: To ascertain the natural history of clinically significant ventricular septal defects, and to examine uncertainties in strategies of management. Methods: We studied prospectively a regional cohort of children born with isolated ventricular septal defects, noting age at presentation; sex; morphology and size of the defect; age at closure, if it occurred, and the means of closure. Results: We identified 290 children with isolated ventricular septal defects, of whom 147 (51%) were male. The mean follow up period was 65 months, with five cases being lost to follow up. Surgical closure was required in 41 (14%) cases, and 155 (54%) defects closed spontaneously. Spontaneous closure occurred in 123 (68%) out of 180 cases with completely muscular borders, and in 31 (29%) of the 107 patients with perimembranous defects. There were two cases with associated aortic regurgitation and no cases of endocarditis. Size and morphology of the defect were significant predictors of spontaneous and surgical closure. In addition, young age at diagnosis was a significant predictor of spontaneous closure. Conclusions: The size and morphology of a ventricular septal defect are important determinants of spontaneous closure and to the need for surgical intervention. Early age at presentation, in contrast, is not predictive of the need for surgical intervention. In early childhood, there appears to be very little risk of endocarditis or aortic valvar prolapse. Neither screening of populations to identify ventricular septal defects, nor surgical closure of asymptomatic defects in childhood, are supported by our findings.

Keywords

Ventricular septal defectlongitudinal studychildendocarditis
Type
Original Articles
Information
Cardiology in the Young , Volume 12 , Issue 4 , July 2002 , pp. 357 - 363
Copyright
Copyright © Cambridge University Press 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Sands, AJ, Casey, FA, Craig, BG, Dornan, JC, Rogers, J, Mulholland, HC.Incidence and risk factors for ventricular septal defect in low risk neonates. Arch Dis Child 1999; 81: F61–63.CrossRefGoogle ScholarPubMed
2.Hiraishi, S, Agata, Y, Nowatari, M 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.CrossRefGoogle ScholarPubMed
3.Du, ZD, Roguin, N, Barak, M, Nasser, N, Hershkowitz, S, Milgram, E.High prevalence of muscular septal defects in neonates. Am J Cardiol 1996; 78: 1183–1185.CrossRefGoogle Scholar
4.Paladini, D, Palmieri, S, Lamberti, A, Teodoro, A, Martinelli, P, Nappi, C.Characterization and natural history of ventricular septal defects in the fetus. Ultrasound Obstet Gynaecol 2000; 16: 118–122.CrossRefGoogle ScholarPubMed
5.Meburg, A, Otterstad, JE, Froland, G, Sorland, S, Nitter-Hauge, S.Increasing incidence of ventricular septal defects caused by improved detection rate. Acta Paediatr 1994; 83: 653–657.CrossRefGoogle Scholar
6.Mehta, VA, Chidambaram, B.Ventricular septal defect in the first year of life. Am J Cardiol 1992; 70: 364–366.Google Scholar
7.Moe, DG, Guntheroth, WG.Spontaneous closure of uncomplicated ventricular septal defect. Am J Cardiol 1987; 60: 674–678.CrossRefGoogle ScholarPubMed
8.Backer, CL, Winters, RC, Zales, VR et al. , Restrictive ventricular septal defect: how small is too small to close? Ann Thor Surg 1993; 56: 1014–1018.CrossRefGoogle Scholar
9.Neumayer, U, Stone, S, Somerville, J.Small ventricular septal defects in adults. Eur Heart J 1998; 19: 1573–1582.CrossRefGoogle ScholarPubMed
10.Onat, T, Ahunbay, G, Batmaz, G, Celebi, A.The natural course of isolated ventricular septal defect during adolescence. Pediatr Cardiol 1998: 19: 230–234.CrossRefGoogle ScholarPubMed
11.Turner, SW., Hunter, S, Wyllie, JP.The natural history of ventricular septal defects. Arch Dis Child 1999; 81: 413–416.CrossRefGoogle ScholarPubMed
12.Gatzoulis, MA, Li, J, Ho, SY.The echocardiographic anatomy of ventricular septal defects. Cardiol Young 1997; 7: 471–484.CrossRefGoogle Scholar
13.Anderson, RC.Congenital cardiac malformations in 109 sets of twins and triplets. Am J Cardiol 1977; 39: 1045–1050.Google Scholar
14.Driscoll, DJ, Michels, VV, Gersony, WM et al. , Occurrence risk for congenital heart defects in the relatives of patients with aortic stenosis, pulmonary stenosis, or ventricular septal defect. Circulation 1993: 87 (Suppl I): I114–I120.Google ScholarPubMed