Twenty-five-year experience with ventricular septal defect in infants and children

Hare, George F. Van; Soffer, Lynn J.; Sivakoff, Mark; Liebman, Jerome

doi:10.1016/0002-8703(87)90759-9

Cited by 30 publications

(11 citation statements)

References 18 publications

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“…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].…”

Section: Discussionsupporting

confidence: 84%

“…Serial hemodynamic studies, however, were selectively done in patients with only moderate or large defects. Others presenting serial catheterization data starting from those aged less than 1 year, in selected patients with large VSD [6,13,16,18,20,46], focused on PVR without mentioning the PAP. An increase in PVR was observed in <10% [16] and development of fixed PVR increase was between 0.7% and 5%, all having large defects.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1999

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To determine the course of right ventricular pressure (RVP) in patients with isolated ventricular septal defect (VSD) and factors influencing it, unselected 148 infants were followed-up longitudinally with color-Doppler echocardiography from a median age of 1 month for 201 patient-years. The patients were divided into three groups by absolute echographic size of VSD: group I, 4 to 7 mm. Sixty percent belonged to group I. Muscular defects dominated in group I, perimembranous defects dominated in group II, and those with outlet extensions dominated in group III. Peak systolic RVP was obtained by Doppler-estimated difference between systolic brachial artery and peak gradient across the VSD. Initial RVP ranged between 15 and 95 mmHg and increased in parallel to the size of defect. According to the regression equations RVP decreased in general by 0.17 mmHg per month. This correlated significantly with the size of the defect. In group I, the rate of decrease was very fast and is best expressed by a log function of time (r = -0.67, r(2) = 0.45). In groups II and III the rate of decrease was less steep and had a greater variability. RVP normalized in 100% in those of group I and in 90% of group II, at median ages of 0.17 and 0.33 years, respectively. Median Q(p):Q(s) values were 1.5, 2.2, and 3.0 in groups I-III, respectively. The outcome depended on the size of VSD. Spontaneous closure was observed in 51% of group I, 10% of group II, and none of group III. The rate was higher in muscular defects. Congestive heart failure was present in 53% and 100% in groups II and III, respectively. Death rate was 2.03%, all in patients with large defects. It is concluded that the temporal course of RVP with time can be estimated fairly well by the regression equation presented in relation to the initial size of the VSD.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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

et al. 1999

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“…In long-term follow-up studies, Kidd et al [23] have found this number to be 7.7%. However, the incidence during childhood is reported to be around 1% [2,8,15,32,34,35].…”

Section: Discussionmentioning

confidence: 99%

The Natural Course of Isolated Ventricular Septal Defect During Adolescence

et al. 1998

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Serial changes in patients with isolated VSD during adolescence have not previously been investigated. Hemodynamic status, diameter of the defect, and growth were studied yearly in 106 children with VSD. The mean duration of the follow-up was 13.16 years and ranged in 80% of subjects from 7 to 19 years (1395 patients years). The mean ages at pre- and postpuberty were 8.62 and 16.67, respectively. The presented longitudinal study, in which losses due to death and operation were minimal (4%), ideally reflected the natural history of VSD. Although weight showed retardation during prepuberty, this lag was caught up by the end of adolescence. Stature showed no retardation in pre- and postpuberty. Cardiothoracic ratio decreased significantly from a mean of 0.48 to 0.44 and showed normal variation. Although the mean defect diameter at prepuberty was 5.33 mm, this decreased to 2.7 postpubertally. The individual decrease (1.7 +/- 2.34 mm) was significant (t = 5.349, p < 1/10(5)). The defect closed spontaneously in 24 (22.6%). In the 75 patients without pulmonary hypertension and with mild left-to-right shunting, 52 remained in the same class and spontaneous closure was observed in 23. In the 24 patients with moderate to severe left-to-right shunt, this decreased in 23 and only one remained stable. The 2 patients (1.9%) with Eisenmenger syndrome remained stable and 1 died. Aortic regurgitation developed in 10 patients (9.4%); however, this was of mild degree in most of them. No infective endocarditis was observed. It is concluded that patients with VSD should be followed closely through adolescence, because the diameter of the defect, as well as left-to-right shunting, can decrease, and it is concluded that the spontaneous closure of the defect is to be expected in a considerable 23%, and aortic prolapse or mild regurgitation may develop in approximately 10%.

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“…The perimembranous type is the most common in adults (about 80% of all VSDs) [1]. The clinical presentation and natural history can vary from small VSD with insignificant left-to-right shunt to VSD with significant left-to-right shunt with left ventricular (LV) volume overload and right ventricular (RV) pressure overload, which, if unrepaired, may cause pulmonary vascular disease and even Eisenmenger syndrome [1,3,4,5]. Patients with a small VSD and insignificant left-to-right shunt or with a repaired VSD usually remain event-free during follow-up.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Patients with Perimembranous Ventricular Septal Defect: Results from the Belgian Registry on Adult Congenital Heart Disease

et al. 2016

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Objectives: Studies evaluating the long-term outcome of adults with ventricular septal defect (VSD) are important to inform patients about prognosis. This study investigated the long-term outcome of patients with perimembranous VSD (pmVSD) followed in the Belgian Registry on Adult Congenital Heart Disease. Methods: All pmVSD patients in the registry were analyzed. Results: Two hundred and sixty-six patients were studied. Fifteen patients had Eisenmenger syndrome. One hundred and seventy-three had isolated pmVSD and 78 had pmVSD with concomitant lesions. Of the patients with isolated pmVSD, 52% were male, median age was 29 years (IQR 24-35 years) and median follow-up duration was 18 years (IQR 10-25 years). Fifty-three (31%) patients underwent VSD closure and 10 (19%) had a residual shunt. Most (93%) patients were in NYHA class I. No patients died. Two (4%) patients developed atrial arrhythmia and 2 (4%) required pacemaker implantation. Seven (14%) developed left ventricular outflow tract obstruction (LVOTO). In the unrepaired pmVSD group, 4 developed endocarditis. In the entire group, moderate or severe aortic regurgitation (AR) occurred in 9 (5%) patients. Conclusions: Long-term survival in patients with isolated pmVSD was not uneventful. Moderate or severe AR might develop and endocarditis occurred in patients without VSD repair. Complications after VSD closure included atrial arrhythmia, pacemaker implantation and LVOTO.

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Twenty-five-year experience with ventricular septal defect in infants and children

Cited by 30 publications

References 18 publications

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

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

The Natural Course of Isolated Ventricular Septal Defect During Adolescence

Long-Term Outcome of Patients with Perimembranous Ventricular Septal Defect: Results from the Belgian Registry on Adult Congenital Heart Disease

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