Summary
We studied 882 cases of isolated ventricular septal defect (VSD) diagnosed from 1971 to 1988 with a mean follow-up period of 9.5 years. They represent 22.5% of all congenital heart defects diagnosed in this period. Six hundred eighty-three children (77.4%) did not develop symptoms, had small defects, and the rate of spontaneous closure was high (40.2%). The remaining 199 children presented symptoms; at the initial catheterization 25, 65, 107, and 2 cases were grouped in hemodynamic groups 2, 3, 4, and 5–6, respectively, on the basis of pulmonary flow and resistance. Only seven patients (0.7%) developed aortic regurgitation, and only five patients (0.5%) developed infective endocarditis. Complete surgical correction was performed in 137 children (15.5% of the total cases), with surgical mortality decreasing from 21.4% before 1983 to 3.5% afterward. Overall mortality was 3% for the entire cohort, 0% for hemodynamic groups 1 and 2, 3% for group 3, and 25% for hemodynamic groups 4–6. About two thirds of the deaths took place between 1 month and 1 year of life, and one thirds of the deaths occurred before surgical treatment. Surgical mortality rates for hemodynamic groups 2, 3, and 4 were 0, 4.7, and 15.3%, respectively. Actuarial survival curves show an important improvement in the prognosis after 1983. Our results stress the importance of early surgical complete correction on patients with large defects and severe hemodynamic changes.
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References
Anderson RP, Bonchek LI, Grunkemeier GL, Lambert LE, Starr A (1974) The analysis and presentation of surgical results by actuarial methods.J Surg Res 16:221–230
Campbell M (1971) Natural history of ventricular septal defect.Br Heart J 33:246–257
Corone P, Doyon F, Gaudeau S, Guerin F, Vernant P, Ducam H, Rumeau-Rouquette C, Gaudeul P (1977) Natural history of ventricular septal defect. A study involving 790 cases.Circulation 55:908–915
Dickinson DF, Arnold R, Wilkinson JL (1981) Ventricular septal defect in children born in Liverpool 1960 to 1969. Evaluation of natural course and surgical implications in an unselected population.Br Heart J 46:47–54
DuShane JW, Weidman WH, Ritter DG (1972) Influence of the natural history of large ventricular septal defects on management of patients.Birth Defects 8:63–68
Hoffman JIE (1988) Ventricular septal defects: Overview of management. In: Anderson RH, Neches WH, Park SC, Zuberbuhler JR (eds)Perspectives in Pediatric Cardiology, vol. 1. Futura Publishing, New York, pp 81–89
Hoffman JIE, Rudolph AM (1970) The natural history of isolated ventricular septal defect, with special reference to selection of patients for surgery.Adv Pediatr 17:57–59
Kaplan EL, Meier P (1958) Non parametric estimation from incomplete observations.J Am Stat Assoc 53:457–482
Keith JD (1978) Ventricular septal defect. In: Keith JD, Rowe RD, Vlad P (eds)Heart Disease in Infancy and Childhood, 3rd edn. Macmillan, New York, pp 320–379
Keith JD, Collins G, Kidd BSL (1971) Ventricular septal defect: Incidence, morbidity, and mortality in various age groups.Br Heart J 33:81–87
Macartney FJ, Taylor JFN, Graham GR, De Leval M, Stark J (1980) The fate of survivors of cardiac surgery in infancy.Circulation 62:80–91
McNicholas KW, Bowman FO, Hayes CJ, Edie RN, Malm JR (1978) Surgical management of ventricular septal defects in infants.J Thorac Cardiovasc Surg 75:346–352
Rein JG, Freed MD, Norwood WI, Castaneda AR (1977) Early and late results of closure of ventricular septal defect in infancy.Ann Thorac Surg 24:19–26
Somerville J (1979) Congenital heart disease: Changes in form and function.Br Heart J 41:1–22
Weidman WH, Blount G, DuShane JW, Gersony WM, Hayes CJ, Nadas AS (1977) Clinical course in ventricular septal defect.Circulation 56(Suppl I):56–69
Van Hare GF, Soffer LJ, Sivakoff MC, Liebman J (1987) Twenty-five-year experience with ventricular septal defect in infants and children.Am Heart J 114:606–614
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Frontera-Izquierdo, P., Cabezuelo-Huerta, G. Natural and modified history of isolated ventricular septal defect: A 17-year study. Pediatr Cardiol 13, 193–197 (1992). https://doi.org/10.1007/BF00838775
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DOI: https://doi.org/10.1007/BF00838775