Diagnosis and follow-up of fetal isolated ventricular septal defect in uterus and the first year after birth using echocardiography / 中华医学超声杂志（电子版）

Objective To evaluate the spontaneous closure of isolated fetal ventricular septal defect (VSD) in uterus and follow-up during the first year after birth using echocardiography. Methods From January 2012 to June 2017, 51 cases with isolated VSD without chromosome abnormality were observed in uterus and followed-up during the first year after birth using echocardiography in People's Hospital of Daxing District in Beijing City. The location, size, closure time of the VSD were recorded. The closure rate was calculated. The closure rate of the VSD in utero and in infant during the first year after birth were compared by Fisher exact probability method. The relation of closure rate and location and size were also analyzed (P＜0.05 was significant). The comparison between groups one by one were performed by Fisher exact probability method (P＜0.0167 was significant). Results In 51cases, 30 had perimembranous VSD, 16 with muscular VSD and 5 with infundibular VSD. In 20 closure cases (39.2%), 9 fetuses (17.6%) were closed in utero, 11 infants (21.6%) were closed during the first year after birth. There was no significant difference between the closure rate of the VSD in utero and the closure rate of VSD in infant during the first year after birth (P=0.804). In 16 with muscular VSD, 11 cases (68.8%) were closed, in whom 4 fetuses (25.0%) were closed in utero and 7 infants (43.8%) were closed during the first year after birth. In 30 perimembranous VSD, 9 cases (30.0%) were closed, in whom 5 fetuses (16.7%) were closed in utero and 4 infants (13.3%) were closed during the first year after birth. The closure rate of muscular VSD were significant higher than that of the closure rate of perimembranous VSD and infundibular VSD (P=0.007, 0.012). There were no significant difference between the closure rate of the perimembranous VSD and infundibular VSD (P=0.297). The infundibular VSD remained unclosed in all cases. In 35 cases with VSD≤3.0 mm, 19 cases (54.3%) were closed, in whom 9 fetuses (25.7%) were closed in utero and 10 infants (28.6%) were closed during the first year after birth. There was 1 closure case (7.6%) with VSD of 3.1-5.0 mm. The closure rate of VSD≤3.0 mm were significant higher than that of the VSD of 3.1-5.0 mm and the VSD＞5.0 mm (P=0.007, 0.013). There was no significant difference between the closure rate of the VSD of 3.1-5.0 mm and VSD＞5.0 mm (P=1.0). The VSD＞5.0 mm remained unclosed in all cases. Conclusions Isolated VSD has a high closure rate in utero and during the first year after birth. Echocardiography was a reliable method in diagnosis and follow-up of isolated VSD.

Analysis of influence factors for spontaneous closure of atrial septal defect and ventricular septal defect in the northern of Xinjiang / 新乡医学院学报

Objective To analyse the risk factors for spontaneous closure of atrial septal defect(ASD) and ventricular septal defect(VSD) in children in the northern of Xinjiang.Methods Ninety-two ASD and sixty-five VSD children in Department of Pediatrics,the First Affiliated Hospital of Medical College,Shehezi University from January 2010 to May 2014 were selected as research subject.According to the spontaneous closure condition of children,the children with ASD were divided into ASD spontaneous closure group and ASD non spontaneous closure group;the children with VSD were divided into VSD spontaneous closure group and VSD non spontaneous closure group.The risk factors for spontaneous closure of ASD and VSD were analysed by single factor and multiple factor logistic regression analysis.Results In 92 ASD children,12 cases (13.04％) were spontaneous closure.In 65 VSD children,9 cases (13.85％) were spontaneous closure.Single factor analysis result showed that there was statistic difference in defect diameter,defect type and the age between spontaneous closure group and non spontaneous closure group in ASD and VSD children (P ＜ 0.05);but there was no statistic difference in defect number and complications between spontaneous closure group and non spontaneous closure group in ASD and VSD children (P ＞ 0.05).Multivariate logistic regression analysis showed that the defect diameter,defect type and the age were the independent risk factors for the spontaneous closure of ASD and VSD (P ＜ 0.05).Conclusion The age ＜ 2 years old,central ASD,perimembranous VSD and defect diameter ＜ 5 mm are important factors for promoting spontaneous closure of ASD and VSD.

A Case of Spontaneous Closure of Macular Hole in Infectious Posterior Uveitis Involving the Fovea

PURPOSE: To report a case of macular hole secondary to presumptive infectious posterior uveitis involving the fovea that spontaneously resolved after medical treatment. CASE SUMMARY: A 33-year-old male visited our clinic for decreased visual acuity in his left eye. He was treated with immunosuppressive therapy including steroid after bone marrow transplantation. Best corrected visual acuity (BCVA) was 0.05 in the left eye. Slit lamp examination showed mild anterior vitritis, and fundus examination showed a macular hole with surrounding whitish infiltration at the fovea. Spectral domain optical coherence tomography (SD-OCT) revealed a full thickness macular hole with surrounding hyper-reflective masses with an infiltration-like appearance involving all retinal layers. Serum anti-toxocara IgG was positive (ELISA), and eosinophil count and immunoglobulin E was elevated. Under diagnosis of presumptive ocular toxocariasis, the patient was treated with albendazole. After medical treatment for toxocariasis, the whitish foveal infiltration became smaller and more discrete. SD-OCT revealed spontaneous closure of the macular hole, and BCVA was improved to 0.4 after a 4-month follow-up. CONCLUSIONS: We report a macular hole complicated by presumptive infectious posterior uveitis that experienced spontaneous closure after medical treatment for underlying infection.

Macular hole formation and spontaneous closure after vitrectomy for rhegmatogenous retinal detachment documented by spectral‑domain optical coherence tomography: Case report and literature review.

This case report describes macular hole (MH) formation and spontaneous closure after vitrectomy for rhegmatogenous retinal detachment (RRD) repair. A 58‑year‑old man referred with a macula‑off superior RRD, in whom vitrectomy was performed. MH with vitreomacular traction (VMT) caused by the posterior vitreous cortex remnants developed 2 weeks after vitrectomy. Four weeks postoperatively, optical coherence tomography revealed resolution of the VMT and spontaneous closure of MH without providing any treatment. This is the first report of an MH formation and spontaneous closure after vitrectomy for RRD. This suggests that the VMT mediated by the posterior vitreous cortex remnants has an important role in the development of secondary MH.

A Case of Spontaneous Closure of Macular Hole in a Previously Vitrectomized Eye

PURPOSE: To report a case of spontaneous closure of a macular hole in a previously vitrectomized eye. CASE SUMMARY: A 71-year-old female had undergone vitrectomy on the left eye due to a secondary epiretinal membrane with vitreous opacity caused by vasculitis. After the procedure, while the patient was still on medication for the recurrent inflammation of the anterior and posterior segment of the vitreous, a macular hole was found after fundus examinations. Visual acuity of her left eye was 0.125 and ocular coherence tomography (OCT) confirmed a full thickness macular hole with a perifoveal cyst. We recommended vitrectomy, internal limiting membrane peeling, and intravitreal gas injection, but the patient refused further intervention due to her poor general condition. After 2 weeks, resolution of the perifoveal cyst with the macular hole was observed. After 13 weeks, OCT revealed the complete closure of the macular hole with normal foveal depression and the patient regained 0.4 visual acuity. CONCLUSIONS: Spontaneous closure of macular hole is a rare phenomenon in vitrectomized eyes, but a small macular hole with inflammation may close spontaneously without additional intervention. Therefore, observation should be considered rather than hasty surgical intervention. Apparently, the spontaneous closure of a macular hole is due to degenerative processes such as development of macular edema and natural recovery.

A Case of Right Coronary Artery to Left Ventricle Fistula with Progression to Spontaneous Closure: Echocardiographic Findings

Coronary artery fistula (CAF) is a rare congenital cardiac anomaly, which mainly drains to the right side heart. As the progression to spontaneous closure in CAF was rare, it needed surgery or catheteric embolization in asymptomatic patients due to the future risk of congestive heart failure, myocardiac infarction or sudden death. With the advent of high resolution two-dimensional and color doppler echocardiography during the past decade, more cases of CAF have been diagnosed and spontaneously closed cases have been increased. Here we report a healthy neonate except heart murmur, who showed a right coronary to left ventricle fistula with progression to spontaneous closure at 11months of age. As the natural course of CAF is still poorly defined and spontaneous closure is increasing, it will be desirable to be followed up regularly by echocardiography in asymptomatic cases, rather than to be corrected surgically.

Natural Course of Atrial Septal Defect Diagnosed Within the First 4 Weeks of Life

PURPOSE: The purpose of our investigation was to explore the natural course, and the factors that influence the natural course, in ostium secundum atrial septal defect(ASD) diagnosed within the first 4 weeks of life. METHODS: We studied patients with ASD diagnosed within the first 4 weeks of life during the period from September 1995 to September 1999 in our hospital. The diagnosis and measuring of the size of ASD was carried out by two-dimensional echocardiogram(2DE, Hewlett-Packard Sonos 2500 ) from subcostal long and short axis views. RESULTS:There were 61 patients - 29 males and 32 females. According to the size of their defects, we divided them into four groups; group A(less than 4 mm : 24 cases), group B(four mm- six mm : 27 cases), group C(six mm-eight mm : six cases), group D(more than eight mm : four cases). In groups A and B, 22 of 24 patients(91.7%) and 23 of 27 patients(85.2%) had each closed spontaneously. In group C, four of six patients had closed spontaneously. In group D, no patient had closed spontaneously and three of four patients had been closed surgically. There were significant differences in the rate of spontaneous closure between less than six mm group and more than six mm group in the size of the defect(P<0.05). There were no significant differences in the rate of spontaneous closure between ASD combined with simple cardiac defect and isolated secundum ASD. CONCLUSION: We conclude that defects smaller than six mm in diameter are very likely to close spontaneously.

Spontaneous Closing Time of PDA in Term and Preterm Infants Without Respiratory Distress Syndrome

PURPOSE: To investigate the spontaneous closing time of PDA in term and preterm infants without respiratory distress syndrome. METHOD: For twenty four term and sixteen preterm infants without RDS, prespective echocardiography was performed within 24hr of birth, which was repeated everyday till spontaneous closure of ductus. At the same time, LA/Ao ratio in M-mode echocardiography and blood pressure were checked. RESULT: In term infants, spontaneous ductal closure rate was 15% in the first day of life, 57.7% in the second day, 88.5% in the third day, and 100% in the fourth day. For the preterm infants without RDS, the spontaneous ductal closure rate was 25%, 73.3%, 86.7%, 93.3% in each day. One preterm infant dided of meningitis at second day of life was excluded. One preterm infant (11,23 who had patent ductus arteiosus at fourth day of llife showed persistent ductus at 6 months of life. CONCLUSION: Spontaneous closure of patent ductus arteriosus will not occur if there is persistent shunt after 4th day of life in term and preterm infants without RDS.

Clinical Course of the Ostium Secundum Atrial Septal Defect(ASD) and Its Rate of Spontaneous Closure

PURPOSE: To know the natural course of the ostium secundum ASD including its rate of spontaneous closure. METHODS: We studied 259 cases who were diagnosed as ostium secundum ASD by 2D-echocardiography at Department of Pediatrics, Kyungpook National University Hospital between Jan. 1985 and Dec. 1994. According to the age at diagnosis, we divided them into two groups, group I (those diagnosed before 1 month of age: 59 cases) and group II (those diagnosed after 1 month of age: 200 cases) RESULTS: Mean age at first diagnosis was 2.6+/-4.6 years and mean defect size(diameter by 2D-echocardiography) was 9.9+/-8.0 mm. Cardiac murmur was the main reason to refer the patients to hospital, being in 50 cases(87%) in group I, 179 cases(90%) in group II. Defect sizes were significantly small in group I compared with group II (5.3+/-3.4 mm vs 11.1+/-6.9 mm, p<0.05). Symptoms corresponding to congestive heart failure were present in 16 cases of group I (27%)( isolated ASD: 8 cases, ASD accompanying with PDA: 5 cases, ASD accompanying with VSD: 2 cases, ASD accompanying both PDA and VSD : 1 case) and in 27 cases of group II(13.5%) (isolated ASD: 17 cases, ASD accompanying with VSD: 4 cases, ASD accompanying with PDA: 4 cases, ASD accompanying both PDA and VSD: 2 cases). Of total 139 cases, spontaneous closure of ostium secundum ASD was documented in 14 cases(10.1%) by follow up 2D-echocardiography. The rate of spontaneous closure was significantly high in group I compared with group II (6 cases: 37.5% vs 8 cases: 6.5%, p<0.05) Comparing with those cases without closure, there were no significant differences in defect size in group I but significant differences in group II(p<0.05), being 5.63 2.62 mm in cases with spontaneous closure and 12.82 7.09 mm in those cases without closure. Of the 9 cases with atrial septal septal aneurysm, 2D- echocardiographic follow ups were possible in 5 cases with spontaneous closure in 2 (40%). CONCLUSIONS: Spontaneous closure was documented in 10.1% of all the patients with ostium secundum ASD. Especially the closure rate was significantly high in those cases their diagnosis was made before 1 month of age and with atrial septal aneurysm.

Cinical Study of Spontaneous Closure in Simple Ventricular Septal Defects / 영남의대학술지

During the period of 9.5 years from September, 1985 to March, 1995, 32 cases with spontaneous closure in simple ventricular septal defect(VSD) were observed and evaluated at Yeungnam University Hospital, and those were confirmed by 2D-echocardiogram. The results were as follows: 1. Among these 32 cases, there were 23 cases(71.9%) of perimembranous VSD, 8 cases(25.0%) of muscular VSD and 1 case(3.1%) of subarterial VSD. Septal aneurysms appears to be main mechanism of spontaneous closure of VSD because of the presence of septal aneurysm in all cases with spontaneous ',;losure of a perimembranous VSD. 2. The size of the defect was variable in diameter, but 27 cases(81.2%) were less than 5 mm. 3. The mean age was 12.1 months at spontaneous closure with the range from 1 month old to 72 months. 4. The mean weight was 9.0 kg at spontaneous closure. 5.--Among these 32 cases, 3 cases had the clinical evidence of cardimegaly or congestive hert -failure during infancy. 6. Male to female sex ratio was 1.5:1

Spontaneous Closure of Ventricular Septal Defect: A Clinical Study of 42 Cases

During a period of 5 years and 3 months, from January, 1980 to march, 1985, 42 cases of ventricular septal defects were observed to be closed spontaneously during their follow up period and were evaluated at pediatric department, hanyang University hospital. 1) Sex incidence shows female preponderance with male to female ration of 1:2. 2) The mean age when they were diagnosed as ventricular septal defect was 5.0+/-6.4 months, and that of VSD murmur last noted was 13.3+/-11.5 months. The mean age when typical VSD murmur disappeared due to spontaneous closure of the defects was 21.1+/-18.7 months. Spontaneous closure of ventricular septal defects disclosed under one year in 22 cases (52.4%). Of those 22 cases, ventricular septal defects were spontaneously closed under 6 months of age in 16 cases(38.8% of whole study population). From the whole study population 90.5%(38 cases) were spontaneously closed under the age of 5 years. 3) Major clinical and physical characteristics before spontaneous closure of ventricular septal defects were typical pansystolic murmur with maximum intensity at left lower sternal border in all cases, palpable thrill in 5 cases(12.8%), ventricular heaves in 4 cases(10.2%) and frequent respiratory infection histories in 27 cases(64.3%). 4) Electrocardiographic findings when they were initially presented as ventricular septal defects revealed normal axis in 28 cases(84.8%), left axis deviation in 3 cases(9.1%), right axis deviation in 2 cases(6.1%) as frontal QRS axis and left ventricular hypertrophy in 8 cases(24.2%), right ventricular hypertrophy in 5 cases(15.6%) and biventricular hypertrophy in 3 cases(8.7%). Other electrocardiographic abnormalities when they had ventricular septal defects were left atrial enlargement in 12 cases(36.4%) and intraventricular conduction delay in 12 cases(36.4%). After spontaneous closure of ventricular septal defects, the electrocardiographic findings revealed normal axis in 36 cases(92.3%), left axis deviation in 3 cases(7.7%) and left ventricular hypertrophy in one case(2.6%). The remaining abnormalities after spontaneous closure of ventricular septal defect were intraventricular conduction delay in 14 cases(35.9%), deep SV6 in 4 cases(10.3%), tall RV6 in 5 cases(12.8%) and long QTc in 1 case(2.6%). Thirty-eight cases(97.4%) do not show ventricular hypertrophy pattern in EKG after spontaneous closure of their defects. 5) When we analyse their frontal plain chest X-ray films after spontaneous closure of ventricular septal defects, cardiomegaly(cardiothoracic ratio)55%) noted in 7 cases(17.9%) and pulmonary plethora in 5 cases(12.8%);while those before the defect were closed spontaneously were 67.6% and 64.7%, respectively. 6) Among 26 cases who underwent follow up 2 dimensional echocardiographic study so-called septal aneurysm were noted with the process of spontaneous closure of ventricular septal defects in 15 cases(57.7%) and the remaining 11 cases do not have any evidence of 'septal aneurysm' even after the completion of spontaneous closure of their defects. In the patient group with so-called 'septal aneurysm' the proportion of female sex was 60% and early systolic clicky sound were heard in 9 patients from 15 cases(60.0%), while those without 'septal aneurysm'were 55% and 18.2%, respectively.