Spontaneous Closure Of Ventricular Septal Defect Research Articles

Spontaneous closure of perimembranous ventricular septal defect in a cat

We discuss the case of a 5-month-old male British Shorthair referred to our hospital following the detection of a heart murmur during a routine vaccination appointment. Two-dimensional echocardiography revealed a 1.18 mm ventricular septal defect (VSD) located immediately below the aortic valve, without signs of secondary cardiac remodeling. Given the absence of cardiac dysfunction, no treatment was administered, and the cat was periodically monitored over the next 2 years. Echocardiography at 29 months of age revealed no signs of the VSD. Future studies are needed to increase the evidence base for spontaneous VSD closure in small animals.

Ventricular Septal Crypts: Remnants of Spontaneous Interventricular Defect Closure?

Background: Ventricular crypts are quite a common finding during cardiac imaging, but their etiology is unclear. A possible final result of a spontaneous ventricular septal defect closure has been supposed but never investigated in earlier studies. Method: From January 1997 to December 2020, all newborns diagnosed to have a ventricular septal defect were prospectively entered in our database and those with an isolated defect were included in the study. Ventricular septal defects were classified into four types: perimembranous, trabecular muscular, inlet and outlet. A long-term follow up was performed in order to visualize the possible residual formation of a septal myocardial crypt. Results: A total of 376 isolated ventricular septal defects (314 muscular and 54 perimembranous, 4 inlet, 4 outlet) were detected. Follow up ranged from 1 to 23 years and showed that, among muscular type, a spontaneous closure occurred in 284 (91%), 26 did not close (8,28%), 2 required surgical intervention (0,63%), 3 were lost at follow up (0,95%). During this period, after spontaneous defect closure closure, 20 crypts were found (6,4%). Conclusion: This study shows that a muscular ventricular septal defect may evolve in the 6.4% of cases in a residual septal crypt. Although septal crypts occur more frequently in patients affected by hypertrophic and hypertensive cardiomyopathy, they may also represent the evolution of a spontaneous closure of a muscular interventricular defect.

Ventricular Septal Defects and Rates of Spontaneous Closure

Research Article| January 01 2020 Ventricular Septal Defects and Rates of Spontaneous Closure AAP Grand Rounds (2020) 43 (1): 7. https://doi.org/10.1542/gr.43-1-7 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Ventricular Septal Defects and Rates of Spontaneous Closure. AAP Grand Rounds January 2020; 43 (1): 7. https://doi.org/10.1542/gr.43-1-7 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: ventricular septal defect, echocardiography Source: Zhao QM, Niu C, Liu F, et al. Spontaneous closure rates of ventricular septal defects (6,750 consecutive neonates). Am J Cardiol. 2019; 124(4): 613– 617; doi: https://doi.org/10.1016/j.amjcard.2019.05.022Google Scholar Investigators from the Children’s Hospital of Fudan University (CHFU), China, and the Royal Hospital for Children, Scotland, conducted a prospective cohort study to assess the incidence of spontaneous closure of ventricular septal defects (VSDs) in infants. Newborns born at 1 of 3 maternity facilities in China during the February–July 2011 study period were enrolled. All newborns received echocardiography before discharge. Newborns with a VSD also received echocardiography at 3, 6, and 12 months of age and then annually until age 7, or until spontaneous closure or surgical intervention, whichever came first. After 6 months of age, newborns with VSDs had follow-up at the Pediatric Heart Center at the CHFU, where standard of care includes surgical or interventional therapy only for infants with VSDs with clinical symptoms or presentation of left heart overload. Demographics and clinical characteristics (gender, birthweight, and gestational age) were collected at enrollment. The primary exposure variable was VSD at birth, classified as perimembranous, muscular, or doubly committed juxta-arterial (DCJA). Size of the VSD was categorized as <4mm or ≥4mm. Muscular VSDs were further categorized into midseptal, apical, posteroinferior, and anterosuperior. The primary outcome variable was spontaneous closure of the VSD by age 7, defined as the absence of color flow mapping on echocardiography. Investigators assessed the proportion of infants with VSD, the proportion with spontaneous closure, and the time to spontaneous closure by VSD type. There were 6,750 newborns born during the study period, all of whom received echocardiography at birth. VSDs were detected in 113 (1.67%), the majority of which were muscular (64%). One patient with a VSD was lost to follow-up. Overall, spontaneous closure occurred in 88 of the 112 of infants with VSD who had complete follow-up data: 18 of 35 (51%) infants with perimembranous VSD, 70 of 72 (97%) infants with muscular VSD, and 0 of 6 infants with DCJA. Factors associated with persistence of VSD were perimembranous (vs muscular) site and size ≥4 mm (vs <4 mm). There was no significant difference in time to spontaneous closure among those with different types of muscular VSDs. The investigators conclude that VSDs are uncommon and that most close spontaneously. Dr Spar has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. VSDs are the most common congenital heart defect (CHD), occurring in 40% of patients with CHDs.1 Previous studies have reported a prevalence of VSDs in the population ranging from 2.5–3.9 per 1,000 live births.2,3 Spontaneous closure of VSDs can occur in up to 90% of defects, mostly with smaller defects.4 Even in those with clinically significant VSDs, closure can occur in 25% (mostly small- to medium-sized VSDs).4 Large shunts can lead to... You do not currently have access to this content.

P1491 Aneurysm of the membranous septum after spontaneous closure of ventricular septal defect combined with bicuspid aortic valve

Abstract An 18-year-old asymptomatic patient with a cardiac background of ventricular septal defect (VSD) and bicuspid aortic valve diagnosed in early childhood, was referred to our Adult Congenital Heart Disease (ACHD) outpatient clinic for routine assessment. Imaging by transthoracic echocardiography and Cardiac Magnetic Resonance (CMR) showed a well-developed multilobulated appendiform saccular formation (34x20mm) arising from the right ventricular side of the membranous septum inferior to the anterior aortic cusp and just beneath the septal leaflet of the tricuspid valve, protruding into the right ventricular outflow tract and the body of right ventricle. The fibrous quality and the absence of myocardium in this structure led to the formation of an aneurysm of the membranous septum (AMS) with the characteristic outpouching or ‘windsock’ appearance from its distention during ventricular systole (Figure). There was no shunt between the ventricles. The aortic valve was true bicuspid with severe aortic regurgitation and an eccentric jet towards the anterior leaflet of the mitral valve. The left ventricle was dilated with preserved systolic function. On the basis of the above information the Heart Team decided for surgical management.Both the presence of a true bicuspid valve (embryologically linked to VSD) as well as the pre-existing left-to-right shunting (until the spontaneous VSD closure) seem to have contributed to aortic valve dysfunction in this case. An interesting physical phenomenon concerning fluid dynamics, known as the ‘Venturi effect’, occurs in patients with ‘aneurysmal transformation’ of the ventricular septum, where the VSD becomes smaller creating thus a low-pressure zone that affects the adjacent aortic valve cusp, causing prolapse and, hence, aortic valve regurgitation. Non-invasive imaging evaluation of patients with AMS is required for optimal diagnosis and treatment as well as for follow-up examinations. Echocardiography is an effective tool for diagnosing AMS, mainly as an incidental finding in asymptomatic subjects whereas CMR is capable of three-dimensional anatomical assessment and provides functional data about the blood flow into the aneurysm and integrity of the ventricular membranous septum. Abstract P1491 Figure

Prediction of spontaneous closure of ventricular septal defect and guidance for clinical follow-up.

AimTo predict the spontaneous closure of ventricular septal defect (VSD) and assist pediatrician to manage VSD children.MethodsBetween January 2008 and December 2016, 132 children diagnosed with isolated VSD by echocardiography were enrolled. All participating children were followed‐up by echocardiography yearly until the closure of VSD or 6 years old. The clinical indicators and echocardiographic parameters of patients were collected. Statistically significant factors were used to establish a Logistic Regression model for predicting spontaneous closure of VSD. Receiver operating characteristic (ROC) analysis was used to assess the specificity and sensitivity of Logistic Regression model.ResultsSpontaneous closure occurred in 60% of all patients; 57% in perimembranous VSD (p‐VSD) and 64% in muscular VSD (m‐VSD) patients. Initial diagnosis age, defect size, aneurysms tissue of the ventricular membranous septum (ATVMS), pulmonary hypertension (PH), and left ventricular diastolic dimension (LVDD) were statistically significant. Defect size, ATVMS and LVDD were determined by the Logistic Regression model as representative factor. P‐VSD and m‐VSD model had areas under the ROC curves 0.854 and 0.898, respectively.ConclusionWe inferred that defect size, ATVMS and LVDD were characteristic and representative predictors for spontaneous closure of VSD. And we summarized the prognostic factors and recommended a follow‐up criteria to assist the pediatrician managing VSD children.

Bacterial Endocarditis in an Intravenous Drug User with a Ventricular Septal Aneurysm

An aneurysm of the membranous portion of the ventricular septum (AMS) is a common complication of spontaneous ventricular septal defect closure. They have been shown to increase the incidence of cardiac pathology notably bacterial endocarditis. Because of such a severe threat, it may be an important anomaly to assess in high risk patients. A 45-year-old woman with a history of intravenous drug use presented in septic shock with end organ damage requiring intubation, broad spectrum antibiotics, and vasopressors. Physical examination displayed a 2/6 systolic ejection murmur heard loudest at the left lower sternal border. Echocardiography confirmed a mobile tricuspid vegetation; as well as, an aneurysmal deformity. During her initial history the patient stated that her VSD had been diagnosed in childhood. A cardiac catheterization showed a membranous ventricular septal aneurysm protruding from the left ventricle into the right ventricle with no evidence of ventricular septal defect. This case exemplifies a patient predisposed to endocarditis who was at higher risk due to her actions. The objective contribution of the AMS to the resultant endocarditis is unknown at this point. This sentiment raises the question if AMS detection would warrant preventative intervention for associated pathologies.

Dilatable pulmonary artery band: Safety and efficacy of balloon dilatation.

Review early and midterm results of dilatable pulmonary artery band (PAB). PAB is performed in various conditions: as a transient stage before ventricular septal defect (VSD) closure, as a palliative procedure for multiple VSD or to prepare the left ventricle (LV) before switch or double switch operations in transposition of the great artery (TGA) or congenitally corrected transposition of great arteries (CCTGA). All children with dilatation of PAB were reviewed. Reason for PAB and for cardiac catheterization, hemodynamics, and outcomes were analyzed. Between 2002 and 2014, 28 patients were identified. Reason for interventional dilatation of the PAB was supra systemic right ventricular (RV) pressure in four patients, aortic recoarctation in one patient, cyanosis in seven patients, RV failure in one patient, suprasystemic LV pressure in two CCTGA patients and spontaneous closure of VSD in other patients. All patients underwent successful balloon dilatation using high (n = 21) or low pressure balloons with a mean diameter of 12 mm. 23 Patients had no further interventions. Five patients had reintervention: one needed two dilatations of PAB and four had surgery (one double switch, one vicious pulmonary artery (PA) band removal, one in a context of severe RV dysfunction with tricuspid regurgitation, and one for VSD closure). One patient died of RV failure following surgery. Balloon dilatation of dilatable PAB carries good results with achievement of hemodynamic aim in most of the cases and definitive treatment in the majority of patients. Careful and sequential dilatation with shunt measurement is mandatory in patients with significantly residual VSD. © 2016 Wiley Periodicals, Inc.

Prospective study on the isolated ventricular septal defect in fetus

Congenital heart defect is one of the most common birth defects. The isolated ventricular septal defect (VSD) has higher morbidity, and spontaneous closure may occur. Previously many studies about the prognosis of ventricular septal defect in childhood were conducted; in contrast, few studies on evolution and prognosis of ventricular septal defect from fetus to postnatal life have been available. This research aimed to determine the evolution of isolated ventricular septal defect during the period of fetus and postnatal life, and analyze the association between the diameter or location of VSD and the spontaneous closure of VSD. All pregnant women seen at the prenatal diagnosis center of the West China Second Hospital were recruited. From June 2011 to June 2014, these participants underwent the fetal 2-dimensional and color Doppler echocardiographic examinations, and the fetuses with isolated VSD were included in the study, and those with other malformations or abnormal chromosome were excluded. This study was a prospective and longitudinal research. These fetuses were followed-up until the VSD closed spontaneously, or were surgically repaired or percutaneously closed. Outcomes of all the cases were recorded. There were 234 fetuses with isolated VSD who were recruited in our research cohort. Twelve of 234 lost to follow-up, 5 of 234 were still in uterus. Totally 217 fetuses were followed up. One hundred eighty-nine of 217 (87.1%) cases were delivered. The pregnancies were terminated in 28 of 217 (12.9%) cases. Ten cases died after birth. Of the 179 delivered cases, the rate of VSD spontaneous closure was 45.2% (81/179), the VSD of 49 cases (27.4%, 49/179) spontaneously closed in uterus. The VSD of 17.9% (32/179) cases spontaneously closed after birth and those of 75% (24/32) cases closed in the first year of life. Furthermore, these participants were divided into 3 groups according to the diameter of VSD in fetus. There were 87 cases in ≤ 2.0 mm group, 51 spontaneously closed (59%, 51/87) and 30 of 84 spontaneously closed (36%, 30/84) in 2.1-5.0 mm group. There were no spontaneous closure in > 5.0 mm group. There was a significant difference in spontaneous closure rate between the 3 groups (χ(2) = 15.200, P = 0.001). Nevertheless, these participants were divided into 2 groups according to the location of VSD in fetus (perimembrane VSD (P-VSD) group and muscular VSD (M-VSD) group). There were 152 cases in P-VSD group, 69 spontaneously closed (45.4%, 69/152) and 12 of 27 spontaneously closed (44%, 12/27) in M-VSD group. There was no significant difference in spontaneous closure between P-VSD and M-VSD (χ(2) = 0.008, P = 0.950). There was a high spontaneous closure rate of VSD in the period of late pregnancy. The most of postnatal VSD were spontaneously closed within one year of age. The spontaneous closure rates of fetal VSD with different diameter were different. The spontaneous closure rate of VSD with smaller diameter was higher.

A ventricular septal defect with a giant appendiform aneurysm of the membranous septum

We report a case of a 39-year-old female with a ventricular septal defect (VSD) and a giant appendiform aneurysm of the membranous septum, illustrated by echocardiography and magnetic resonance imaging. From the literature a short review of the prevalence of spontaneous closure of VSDs together with the possible complications of persisting VSDs is presented. Since patients stay at risk in later years, follow-up at regular intervals is advised.

Long-term follow-up of pseudoinfarction pattern in two children

Pseudoinfarction is defined as the presence of abnormal Q-waves with or without ST-segment changes which are not associated with myocardial ischemia. In adults, different causes of pseudoinfarction pattern have been described in cardiac diseases [1] associated with cardiomyopathy [2], hyperkalemia [3] or Wolf–Parkinson–White syndrome [4], and extra cardiac causes such as acute pancreatitis [5]. There is only one report about pseudoinfarction in infancy with symptomatic congestive heart failure, which was caused by the presence of an accessory atrioventricular conduction pathway and most likely intermittent supraventricular tachycardia [6]. We report about two children who were admitted in the outpatient clinic to clarify the heart murmur and found to have ECG abnormalities without any signs of clinical impairments. First patient was a 5-day-old female infant with a small membranous ventricular septal defect (VSD). Her ECG showed sinus rhythm, right axis deviation with deep Q-waves (up to -0.5 mV) in leads II, III, aVF and in pre cordial leads V4–V6. In addition, there was a discrete ST-elevation up to 0.2 mV in leads II and aVF. At the age of 6 weeks and 3.5 months, we observed left axis deviation with deepening of above mentioned Q-wave in ECG (Fig. 1a). Her clinical status was totally normal. The echocardiography confirmed normal size and function of the heart with hemodynamically not relevant left-to-rightshunt through the small membranous VSD. The second patient was a 2.5-year-old boy also with a small membranous VSD. Although in his first years of live, the ECG’s showed normal conduction, the ECG abnormalities were observed at the age of 2 years with extreme left axis deviation and deep Q-waves (up to -0.7 mV) in leads I, aVF and pre cordial leads V4–V6 without significant ST-elevation (Fig. 1b). His clinical status showed no impairments. Physical ability was not limited and there were no episodes of chest pain or dyspnoea in the past medical history. The echocardiography confirmed also in this case normal size and function of the heart with hemodynamically not relevant left-to-right-shunt through the small membranous VSD. The blood work, including CK and CK-MB was within normal range for both patients. The echocardiogram was not thought to have completely ruled out the possibility of a coronary artery abnormality, and angiographic visualization of the coronary arteries was considered appropriate to rule out anomalous left coronary artery from the pulmonary trunk (Bland–white–Garland syndrome). In both cases, the angiography showed a normal anatomy of the heart, great vessels and the coronary arteries. The hemodynamic evaluation was also entirely normal. The already by echocardiography described small membranous VSD was confirmed in both patients. A continuous follow-up investigation revealed in first patient (latest 6 years after initial investigation) a normal ECG (Fig. 1c) with spontaneous closure of VSD and in A. Wessel K. Norozi Department of Paediatric Cardiology, Medical School Hannover, Hannover, Germany

Spontaneous Closure of a Ventricular Septal Defect in a Horse

Spontaneous Closure of a Ventricular Septal Defect in a Horse

Management of Infants with Coarctation and Ventricular Septal Defect

The management of patients with aortic coarctation and ventricular septal defect (VSD) remains controversial. A 2-stage repair uses staged coarctation repair +/- pulmonary artery banding followed by VSD closure with 2 separate operations. This has the advantage of a straightforward coarctation repair (except in the case of proximal arch hypoplasia) and a simpler VSD closure at a later date. A subset of patients will have spontaneous VSD closure that obviates the need for subsequent operation. Disadvantages include a period of palliation between operations and the complications of a pulmonary band. A single-stage approach involves simultaneous coarctation repair and VSD closure on cardiopulmonary bypass with circulatory arrest or regional perfusion during coarctation repair. This has the advantages of complete repair in infancy without palliation and the ability to deal with proximal arch hypoplasia. Disadvantages include a technically more challenging operation and the need for circulatory arrest or regional cerebral perfusion. Some series have suggested a higher risk for recoarctation. An alternative method involves coarctation repair without cardiopulmonary bypass through a thoracotomy followed by VSD closure during the same operation (1 stage, 2 incisions). This affords excellent clinical results with complete repair in infancy. One can avoid prolonged periods of aortic cross clamping, cardiopulmonary bypass, and circulatory arrest/regional perfusion. Compared with the other strategies, there are decreased total intensive care unit and hospital stays.

Clinical Study of Spontaneous Closure in Simple Ventricular Septal Defects

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 closure 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.

Surgical management of neonatal coarctation

Between 1983 and 1994, 307 consecutive neonates underwent coarctation repair by a single surgical technique: extended end-to-end anastomosis. Mean age at operation was 13 ± 8 days. Isolated coarctation was present in 95 patients (group 1), 102 patients had associated ventricular septal defect (group 2), and 110 patients had associated complex intracardiac lesions (group 3). Aortic arch hypoplasia was present in 81% of the patients (62% in group 1 versus 85% in group 2 and 93% in group 3: p < 0.001). In 271 patients, the aortic arch reconstruction was performed via a left thoracotomy with normothermia (100% of group 1, 95% of group 2, and 72% of group 3); in the other 36 patients, undergoing one-stage repair or palliation of the associated lesion, it was performed via a midline sternotomy during a short period of deep hypothermia and circulatory arrest (5% of group 2 and 28% of group 3). Pulmonary artery banding was performed in 94 patients. Spontaneous ventricular septal defect closure was observed in 39% of the patients of group 2 operated on via thoracotomy. Early mortality rates in groups 1 (2%) and 2 (2%) were significantly lower than in group 3 (17%) ( p < 0.001). There were 29 late deaths, all related to associated cardiac lesions or their subsequent repair. The overall total mortality was 16.9%. In group 3 this rate was significantly higher in patients undergoing two-stage procedures (47%) than in those undergoing one-stage repair (23%) ( p < 0.05). All but 14 survivors were followed up for a mean of 61 ± 36 months. Actuarial survivals at 10 years were 98% in group 1, 94% in group 2, and 60% in group 3. The recoarctation rate was 9.8%, leading to 21 reoperations and three angioplasties without mortality. Patients with a more extended or severe form of aortic arch hypoplasia had a significantly higher risk of recoarctation ( p < 0.001). Actuarial freedom from reoperation for recoarctation at 10 years was 93%. The findings of this study suggest that extended end-to-end anastomosis provides an adequate and safe repair of neonatal coarctation. Low recoarctation rate, owing to effective relief of the obstruction created by aortic arch hypoplasia and to complete resection of ductal tissue, freedom from major morbidity, and feasibility via both lateral and anterior approaches are the main advantages of the extended end-to-end anastomosis. Mortality is mainly dependent on the complexity of the cardiac associations. Successful management of the majority of the neonates with coarctation and associated ventricular septal defect is possible with repair of coarctation alone. One-stage repair of neonatal coarctation and associated complex heart defects (with indication for two-ventricle repair) by means of an anterior approach provides a better outcome than a two-stage repair. (J T HORAC C ARDIOVASC S URG 1995;109:663-75)

Spontaneous closure of uncomplicated ventricular septal defect

The charts of 222 patients with a diagnosis of ventricular septal defect (VSD) were reviewed to determine the overall incidence, the prevalence of membranous and muscular defects and the rates of spontaneous VSD closure. VSD diagnosis and location were determined primarily from reports of 2-dimensional and pulsed Doppler echocardiograms. In a 5-year period, VSDs occurred in 3.85 1,000 live full-term births and 7.06 1,000 live premature births. The VSD closed spontaneously in 20 of 44 patients (45%) followed from birth (University Hospital group) during a mean follow-up of 12 months. Of 165 patients not followed from birth (referred group), the VSD closed spontaneously in 37 (22%). Overall, VSD location was determined in 101 of 209 patients (48%) and was distributed as follows: membranous 66 (65%), muscular 32 (32%) and subpulmonic 3 (3%). Rates of spontaneous closure for membranous and muscular VSDs were 37% and 50%, respectively, for the University Hospital group and 9% and 9%, respectively, for the referred group (no significant difference in either case). Surgical closure was required in 30 of 165 referred patients (18%) and only 1 of 44 University Hospital patients (2%). There was no significant difference in rate of closure for premature vs fullterm infants or small vs larger defects. Data for patients followed from birth more likely reflect the true natural history of VSD.

Combined discrete subaortic stenosis and ventricular septal defect in infants and children

Eight patients, aged 1 to 8 years, with discrete subaortic stenosis (DSS) and ventricular septal defect (VSD) were studied by 2-dimensional (2-D) and M-mode echocardiography. Initial cardiac catheterization and angiocardiography showed VSD and other associated cardiac lesions, including coarctation of the aorta and patent ductus arteriosus. None had evidence of DSS. Six patients underwent surgical repair of the associated lesions, but none required closure of the VSD. Ultimately, 6 patients had spontaneous closure of VSD, and 2 had a residual small VSD. Subsequent serial echocardiography showed evidence of subaortic membrane, prompting repeat cardiac catheterization, which confirmed moderate to severe peak systolic pressure gradients between the left ventricle and ascending aorta. Surgical resection of the membrane was performed in 5 patients. Thus, in patients with small or spontaneously closed VSDs, DSS may develop. Evaluation of the left ventricular outflow tract area is recommended in patients with small or closed VSD in whom a significant heart murmur or electrocardiographic abnormality remains.

Natural history of congenital heart disease. Problems in its assessment with special reference to ventricular septal defects.

It is difficult to make prognoses and decisions on therapy of individuals with congenital heart disease (CHD) and plan efficiently for medical services and training programs because studies on the incidence and relative frequency of different types of CHD at birth, mortality rates, times of death, and prevalence rates in children and adults are incomplete or unrepresentative. The present study assesses the merits of previous surveys and attempts to indicate the best information about these rates. Specific attention has been directed to data on ventricular septal defect (VSD), with an estimated incidence of at least 20/10,000 live births; about 10% of these children died before 15 years of age. There should thus be about 18/10,000 surviving school children with VSD, yet the most intensive school surveys show only about half this number. This supports the suggestion that there is a high incidence (perhaps 50%) of spontaneous closure of VSD during childhood. Spontaneous closure may also occur frequently after childhood, but this conclusion needs to be confirmed by better surveys.