Further Observations on the Natural History of Isolated Ventricular Septal Defects in Infancy and Childhood

Abstract

IN THE past few years several reports on the physiologic changes in ventricular septal defect with increasing age, based on serial cardiac catheterization studies, have appeared in the literature.'-'0 The results of these investigations have not been uniform, and variable conclusions have consequently evolved. A number of workers' 4-6 suggested that progressive pulmonary hypertension and rapidly increasing pulmonary vascular obstruction hardly occur in childhood, whereas others7-9 indicated that these changes are not uncommon at this age. Recently, Lucas et al.'0 demonstrated varying hemodynamic changes in large ventricular septal defects, which they related to variations in the maturation process of the pulmonary vascular bed. This paper is a continuation of previous communications from this Departmentl-3 on the serial hemodynamic findings in ventricular septal defect. To date, a total of 75 patients with isolated ventricular septal defect have had serial cardiac catheterization studies. The results confirm our previous observation that there is a distinct tendency for the elevated pulmonary artery pressure and pulmonary blood flow to fall in the first few years of life. By the second half of the first decade or later, these changes are rarely ob-

Ventricular Septal Defect: A Study of its Natural Course in Infancy and Childhood

“…This incidence is in accord with earlier reports in the literature [2,17,18,28,35]. These patients were all initially found to have elevated pulmonary arterial pressure and were classified in group 2 and 3.…”

Regression of Right Ventricular Pressure in Ventricular Septal Defect in Infancy: A Longitudinal Color-Flow Doppler Echocardiographic Study

“…In our other long-term follow-up study, which includes adolescents [28], this was observed in only two patients (1.9%) and PAP had normalized between ages 4 and 6 years in most [30]. Consistent with the duration of the series presented here, the incidence of Eisenmenger syndrome was found to be rare in the first 4 years of life [3,4,6,7,18,40,46,47].…”

“…Our results in relation to RVP can therefore not be compared with them. Some, with age and severity grade representing fairly the "natural" distribution of VSD with satisfactory long-term follow-up results, found that the incidence of PH fell significantly and the ratio of Eisenmenger was between 1% and 2% [3,4,48]. Serial hemodynamic studies, however, were selectively done in patients with only moderate or large defects.…”

The Ventricular Septal Defect in Tricuspid Atresia: Its Natural History and Surgical Importance

“…[1][2][3][4] Since that time, several groups of workers have further confirmed the phenomenon of spontaneous closure of isolated VSDs both clinically and by angiography. [5][6][7][8][9] This phenomenon is not confined to infants but also occurs in older children and adults. 3,7,10,11 Spontaneous closure has been reported in small and large defects.…”