Prediction of spontaneous closure of ventricular septal defect and guidance for clinical follow‐up

Abstract

Aim To predict the spontaneous closure of ventricular septal defect (VSD) and assist pediatrician to manage VSD children. Methods Between January 2008 and December 2016, 132 children diagnosed with isolated VSD by echocardiography were enrolled. All participating children were followed‐up by echocardiography yearly until the closure of VSD or 6 years old. The clinical indicators and echocardiographic parameters of patients were collected. Statistically significant factors were used to establish a Logistic Regression model for predicting spontaneous closure of VSD. Receiver operating characteristic (ROC) analysis was used to assess the specificity and sensitivity of Logistic Regression model. Results Spontaneous closure occurred in 60% of all patients; 57% in perimembranous VSD (p‐VSD) and 64% in muscular VSD (m‐VSD) patients. Initial diagnosis age, defect size, aneurysms tissue of the ventricular membranous septum (ATVMS), pulmonary hypertension (PH), and left ventricular diastolic dimension (LVDD) were statistically significant. Defect size, ATVMS and LVDD were determined by the Logistic Regression model as representative factor. P‐VSD and m‐VSD model had areas under the ROC curves 0.854 and 0.898, respectively. Conclusion We inferred that defect size, ATVMS and LVDD were characteristic and representative predictors for spontaneous closure of VSD. And we summarized the prognostic factors and recommended a follow‐up criteria to assist the pediatrician managing VSD children.

Treatment of ventricular septal defect in children: Who, when, and how? A 20-years Lebanese multicentric retrospective study

“…Adverse events such as severe and irreversible PAH (Eisenmenger syndrome), failure to thrive, infective endocarditis, aortic insufficiency, left ventricle volume overload, right ventricle outflow tract obstruction, double chamber right ventricle, and congestive heart failure during infancy and childhood are factors that directs the decision towards surgery as a treatment. Appearance of these complications early in life is also an indication for surgery [6,12]. VSD area indexed to body surface area (BSA) and VSD indexed to aortic valve ratio were the most significant echocardiographic variables found to be independently associated with the need for surgical intervention, they are also easily obtainable and would potentially help risk-stratify asymptomatic patients with VSDs to guide surveillance, regardless of the type or location of the defect [21].…”

“…According to their experience, their combination is still insufficient to direct therapeutic approach and cannot be generalized In addition, the duration from diagnosis to surgery, period and intensity of follow up were unfixed. Furthermore, a Chinese experience, based their decision for treatments options on different combinations of clinical, imaging data and echocardiographic factors model, which still need validation [12]. The recommended period and intensity of follow-up were once every 1 or 2 years for small VSD and a yearly follow up for medium and large VSD.…”

“…Previous researches showed that VSDs can close spontaneously overtime, proving that patients could avoid any type of intervention and undergo simple monitoring with or without anti-congestive medications [10]. Nonetheless, the rate of spontaneous closure (SC) remains controversial, ranging from 4% to 83%, and depends on age, gender, size and site of the defect as well as many other factors [11,12].…”

Tratamiento de la Comunicación Interventricular (CIV) congénita con dispositivos de inserción percutánea y perventricular

“…Otro aspecto relevante que hay que tener en cuenta es el tamaño del defecto de la CIV. Cuando éste es de gran magnitud, se asocia con una ausencia de cierre espontáneo de la CIV 108 . El tamaño de la CIV se trata de un factor pronóstico, de tal manera que cuanto mayor es el tamaño de la CIV mayor es el riesgo, tras la intervención de corrección de la CIV, de necesitar una reintervención por la aparición de un shunt residual significativo 85,109,110 .…”

Biomarkers for isolated congenital heart disease based on maternal amniotic fluid metabolomics analysis

“…Furthermore, CHD is not constant during pregnancy, and it may be dynamically change. For example, up to 60–80% of ventricular septal defects (VSD) can spontaneously recover [ 10 , 11 ]. Therefore, whether a relatively objective inspection method could be developed to increase the prediction effect of CHD in later development needs be considered.…”