The natural history of ventricular septal defects in infancy and childhood

Lynfield, Joshua; Gasul, Benjamin M.; Arcilla, René A.; Luan, Lawrence L.

doi:10.1016/0002-9343(61)90046-8

Cited by 63 publications

(11 citation statements)

References 21 publications

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“…The incidence of other secondary lesions, i.e. aortic and pulmonary incompetence is in agreement with reports by others [23,27]. Infundibular stenosis was demonstrated on angio cardiography in 3 cases but there was no evidence that this ab normality was secondary to the basic lesion.…”

Section: Discussionsupporting

confidence: 92%

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

Olin¹,

Rudhe²,

Wallgren³

1968

Cardiology

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Section: Discussionsupporting

confidence: 92%

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

Olin¹,

Rudhe²,

Wallgren³

1968

Cardiology

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“…Clearly operation should not be deferred too long if PVR is raised and appears to be progressing at repeated catheter studies. Pulmonary vascular disease may be capable of regressing completely up to the age of 2 years if the causal defect or defects are repaired (Lillehei et al, 1964), but if operation is left until after childhood this is less likely to take place (Lynfield et al, 1961;Hallidie-Smith et al, 1969. One of our patients (case 3) was found to have pulmonary hypertension with a PVR of four units and Rp: Rs ratio of 025: 1 at the age of 5 months.…”

Section: Discussionmentioning

confidence: 76%

Pulmonary hypertension accompanying ventricular septal defect and patent ductus arteriosus. Management in infancy and early childhood.

Reid¹,

Coleman²,

Stevenson³

1979

Thorax

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Forty-one infants and children with the combination of patent ductus arteriosus (PDA) and ventricular septal defect (VSD) were encountered over 20 years. Twenty-four presented in infancy with congestive cardiac failure. Pulmonary hypertension was present in 32, the cause in 19 being increased pulmonary blood flow. Increased pulmonary vascular resistance (PVR) was detected in 13 (indicated by a pulmonary to systemic resistance ratio (Rp : RS) >0 24 1 and PVR>4 units). Thus 22% had a pulmonary artery systolic pressure less than 30 mmHg and 68% had a pulmonary vascular resistance below four units, indicating an unusually mild form of the combined condition in these patients. Surgical management is discussed, and in particular the question of simultaneous closure of the defects during infancy. Cardiac failure, resistant to drug treatment, and increased PVR are indications of operation. The PDA should be closed and only if there is no substantial fall in pulmonary artery pressure is the VSD repaired.Although both ventricular septal defect (VSD) and patent ductus arteriosus (PDA) are common congenital cardiac anomalies occurring singly, the two combined are relatively uncommon (Hallman et al, 1964;Cartmill et al, 1966;Keith et al, 1978).Because of the existence of two separate systemic-pulmonary arterial shunts, pulmonary hypertension would be expected as a common accompaniment and congestive cardiac failure a common presentation in infancy. We present our experience with this combination of defects in 41 infants and children, most of whom were under the age of 2 years. Patients and methodsDuring 1959-78 41 infants and children presented with the combination of PDA and VSD. Patients with additional anomalies (atrial septal defect, coarctation of aorta, and aortic stenosis) were excluded. Thirty-two patients were female and nine male, the age at presentation ranging from 1 month to 11 years (mean 19-7 months) (

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“…Thus patients with large shunts who survive infancy without operation are likely to develop further pulmonary vascular changes probably due largely to the voluminous blood flow through the lungs and the markedly raised pressure. Lynfield, Gasul, Arcilla, and Luan (1961) stressed that when infants with ventricular septal defect develop symptoms in the first year of life, the prognosis without operation is bad due to increasing pulmonary hypertension and pulmonary vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary artery banding in congenital heart disease associated with pulmonary hypertension

Reid¹,

Barclay²,

Coleman³

et al. 1968

Thorax

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A report is presented of pulmonary artery banding in 45 children with congenital heart disease associated with severe pulmonary hypertension. The majority were in uncontrollable heart failure and were in the age group 3 to 18 months. Nine older children not in 'heart failure were operated on because of serious pulmonary hypertension associated with malformations considered unsuitable for complete repair (truncus arteriosus, single ventricle). The mortality in those with uncomplicated ventricular septal defect was low (5.5%), but was much higher in those with accompanying lesions or more complex abnormalities (63% months, and the eldest of the remaining eight was 10 years. The majority were infants and very young children who had congestive cardiac failure accompanying pulmonary hypertension at or close to systemic level not fully responsive to digitalization and intensive diuretic therapy, and who were not thriving and unlikely to survive early childhood. By contrast the older children were not acutely ill but had exertional dyspnoea, radiographic evidence of cardiac enlargement, and pulmonary hypertension ranging from 75/0 to 160/20 mm. Hg. The reason for not carrying out a complete repair of their cardiac lesions in preference to pulmonary artery banding will be discussed later. Table I presents details of a diagnostic classification related to death at operation and survival. The diagnosis was made by cardiac catheterization and angiocardiography and was confirmed at either operation or necropsy. RESULTS GROUP 1 These patients had a ventricular septal defect with pulmonary hypertension and no other abnormality. The group comprised 18 of our 45 patients, and their ages ranged from 3 months to 9 years. With the exception of three children aged respectively 3, 8, and 9 years, the remainder were 17 months or younger and were admitted with severe congestive cardiac failure and failure to thrive. As intensive medical management failed to alleviate their symptoms, full cardiac investigation was undertaken. 385 2G on 11 May 2018 by guest. Protected by copyright.

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The natural history of ventricular septal defects in infancy and childhood

Cited by 63 publications

References 21 publications

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

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

Pulmonary hypertension accompanying ventricular septal defect and patent ductus arteriosus. Management in infancy and early childhood.

Pulmonary artery banding in congenital heart disease associated with pulmonary hypertension

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