Clinical outcome of small ventricular septal defects [VSDs] in children

ABSTRACT

To assess the clinical outcome of patients with isolated ventricular septal defects small enough not to require surgical closure. Between January 2001 and May 2003 a total of 118 patients who were recently or previously diagnosed to have isolated ventricular septal defects small enough not to require surgical closure were included in this study. Inclusion criteria for the study were single ventricular septal defect with a size less than 5 mm in diameter on a 2-D echo, normal or borderline left ventricular end diastolic diameter [20-44 mm], normal left ventricular fractional shortening [0.30-0.40], normal or slightly raised pulmonary artery pressure [less than 30/15 mmHg, with a mean less than 19 +/- 7 mmHg] and absent ventricular septal defect-related clinical symptoms. Exclusion criteria were symptomatic small ventricular septal defect patients and those who had an additional hemodynamically relevant heart defects. Follow up period was recorded. Mean age of the study population at presentation was 13.3 +/- 1.4 months [range, one week-10 years] and at last follow-up visit 6.0 +/- 0.7 years [range 2.5-12.5 years]. Follow-up was performed for 111 patients [94 percent]. The mean follow up period was 5.5 +/- 0.6 years [pre- and post enrollment]. Spontaneous closure was observed in 12 of perimembranous, and 10 of muscular ventricular septal defects [overall rate of spontaneous closure 19.8 percent], by the end of the study. None of the patients died nor required medical or surgical treatment. Two patients developed mild aortic insufficiency and two patients had infective endocarditis during the follow-up period. None of the patients had definite increasing dimensions or functional deterioration of the left ventricle. Twenty-five patients underwent exercise treadmill testing; 84 percent of those achieved a target heart rate more than 80 percent of age-predicated maximum heart rate. None had a target less than 70 percent of predicated maximum heart rate or any exercise-induced significant arrhythmias. On the other hand 21 percent showed non-significant rhythm abnormalities either at resting electrocardiogram or 24-hour Holter monitoring. The overall clinical outcome of asymptomatic children with small isolated ventricular septal defect is excellent. Spontaneous closure may occur and these children may be allowed to participate freely in physical exercise and engage in competitive sports. Clinical and 2-D echo follow-up are indicated