Prognosis and related factors in ventriküler septal defect cases

AIM: To determine the natural course and related factors in isolated VSD cases. MATERIAL AND METHOD: 177 VSD cases diagnosed by echocardiographic assesment in Adnan Menderes University Pediatric Cardiology Department, between January 2007- December 2011 were retrospectively evaluted. RESULTS: Muscular VSD was the most common type (57,9%) among 119 isolated VSD cases diagnosed in the first three months of life. Membranous VSD was the second most common type . Mean diameter of muscular VSD group was smaller than membranous group. Although VSD was slightly more common in girls, it was not statistically significant. Mean SDS of VSD cases at birth were negative pointing out an intrauterine growth retardation. Mean SDS values were normalized in 2-4 th month when the septal defects< 4 mm, while growth retardation persisted in larger defects. A limited number of cases with small muscular VSD without murmur were also present in our study group. Spontaneous closure rate was higher in muscular defects which can be attributable to smaller defect size in this group. Among cases with ?4 mm defect size, closure rate up to 6 months was found to be 46% in muscular VSD compared to 24% in membranous cases, where as up to two years this rate were 79% and 61% respectively. Spontaneous closure was not achieved after two years. Only one case with membranous VSD > 4 mm was spontaneously closed with septal aneurysm. Membranous VSD < 2 mm was closed without septal aneurysm, while more than half of the cases with 2-4 mm closed with septal aneurysm. 7,3% of the cases required surgery (5,6% surgical correction, 1,7% banding), none of them were < 6 mm. None of the cases needed preoperative angiocardiography. In surgical cases, flow gradient in pulmonary valve was above 15 mmHg indicating increased pulmonary blood flow. Both left and right ventricular dilatation were observed as a consequence of the left to right shunt. VSD size was strongly related with left ventricul and left atrium diameters and independent from left ventricul/ aort and left atrium/aort ratios. Subaortic discrete membrane, aortic valve insufficiency, aortic valve prolapse, infundibular stenosis was quite rare.( frequency less than 3%). Bacterial 52 endocarditis was not observed. There was no mortality in the surgery. There was no residual VSD with hemodynamic significance after surgery. Two of three small residual VSD cases were closed spontaneously. CONCLUSION: Small muscular defects were the most common type among VSD cases diagnosed in the first three months of life. Spontaneous closure was achieved in the first two years of life if the defect is < 4 mm. Surgery was required in cases with > 6 mm. Subaortic discrete membrane, aortic valve insufficiency, aortic valve prolapse, infundibular stenosis were quite rare. In conclusion with appropriate management isolated VSD is a benign disease in most of the cases. Keywords: Ventricular septal defect, prognosis, children, echocardiography