Résumé
Anteriorty malaligned ventricular septal defects [VSDs] have variable presentation and echocardiographic evaluation is needed to identify associated lesions. This work aims to study the echocardiographic Findings in patients with ventricular septal defect and anterior deviation of the cadet septum, and to determine whether this finding can predict clinical course in infants with this congenital heart lesion. The study included 60 infants and children with paramembranous VSD were enrolled in this study; group I included 30 cases with anterior malaligned outlet septum detected echocardiographicatly and the other 30 cases had an isolated type of this defect as controls. Clinical findings, radiological data and ECG records were reviewed in both studied groups with a comparison of associated lesions assessed by echocardiography. The results showed that dyspnea was the most common presentation and repeated attacks of acute congestive heart failure with recurrent chest infection were the major problems in group I compared to the findings in group II. Radiological evidence of cardiomegaly was 73.3% in group I versus 40% in group II with a left ventricular predominance in 46.6% in group I versus 13.3% in group II. Ventricular hypertrophy in ECG records correlated well with the chest X-ray findings. Progressive infundibutar subpulmonary narrowing was a cardinal morphologic feature in malaligned type at VSD with an incidence of 33.3%. In group I, pulmonary hypertension and heart failure complicated 53.3% and 60% respectively of the studied cases in this group
Conclusion: The presence or absence of malalignment should be clearly defined in all patients with a ventricular septal defect, because these patients had a significant higher incidence of associated lesions, and the potential for the development of complications. The surgical therapeutic management of these patients should take this in account