Small Ventricular Septal Defect Considered not Requiring Surgical Closure: The Frequency of Developing Complications in Our Center
DOI:
https://doi.org/10.17140/HROJ-2-126Keywords:
Ventricular septal defect, Aortic cusp prolapsed, Aortic regurgitation, Right ventricular outflow track obstruction, Left ventricular outflow track obstruction.Abstract
Objectives: The study was conducted to check the frequency of development of complication
in the patients with small Ventricular Septal Defects (VSDs) considered not requiring surgical
closure during childhood.
Methods: A descriptive study was conducted on children from January 2015 to December 2015
at Children Hospital and Institute of Child Health, Lahore, Pakistan. The data with isolated
VSDs considered too small to require surgery from 1 month to 15 years of age were reviewed.
The data was analyzed with SPSS 20 version.
Results: The total of 883 patients of restrictive VSDs considered not to require surgery, 60.6%
(n=535) were males and 39.4% (n=348) were females. The significant number of patients
i.e. 18.7% (n=166) developed complications. Aortic cusp prolapsed developed in 13.6% i.e.
p≤0.05, 2.3% developed aortic regurgitation secondary to aortic cusp prolapsed. 1.8% developed
right ventricular track outflow obstruction (RVOT) i.e. p≤0.05 and 0.3% of patient developed
left ventricular outflow track obstruction (LVOT) i.e. p≤0.05. Similarly 0.8% patients
developed endocarditis. Regarding types of VSD, we found Perimembranous in 65.8%, muscular
in 12.6%, Subaorticin 8.3%, doubly committed in 6.0%, Inlet in 5% and outlet in 1.7%
of our patients.
Conclusions: Patients with small restrictive Ventricular Septal Defects (VSDs) generally been
considered as do not required surgery, the data suggested that a significant percentage of these
patients developed complications later in their life i.e., 18.7%.
References
Sadiq M, Roshan B, Latif F, Bashir I, Sheikh SA, Khan A. Pat-tern of pediatric heart disease in Pakistan. J Col Physicians Surg Pak. 2002; 12(3): 149-153. Web site. https://inis.iaea.org/search/ search.aspx?orig_q=RN:34015814. Accessed March 19, 2016.
Soto B, Becker AE, Moulaert AJ, Lie JT, Anderson RH. Clas-sification of ventricular septal defects. Br Heart J. 1980; 43: 332-343. doi: 10.1136/hrt.43.3.332
Bloomfield DK. The natural history of ventricular septal de-fects in patients surviving infancy. Circulation. 1964; 29: 914- 955. doi: 10.1161/01.CIR.29.6.914
Dickinson DF, Arnold R, Wilkinson JL. Ventricular septal de-fect in children born in Liverpool 1960 to 1969. Evaluation of natural course and surgical implications in an unselected popula-tion. Br Heart J. 1981; 46(1): 47-54. doi: 10.1136/hrt.46.1.47
Campbell M. Natural history of ventricular septal defect. Br Heart J. 1971; 33(2): 246-257. Web site. http://www.ncbi.nlm. nih.gov/pmc/articles/PMC487172/. Accessed March 19, 2016.
Alpert BS, Cook DH, Varghese PJ, Rowe RD. Spontaneous closure of small ventricular septal defects: Ten-year follow-up. Pediatrics. 1979; 63(2): 204-206. Web site. pediatrics.aappub-lications.org/content/63/2/204?variant=long&sso=1&sso_redi-rect_count=1&nfstatus=401&nftoken=00000000-0000-0000- 0000-000000000000&nfstatusdescription=ERROR%3a+No+lo cal+token. Accessed March 19, 2016.
Keith JD, Rose V, Collins G, Kidd BS. Ventricular septal de-fect: Incidence, morbidity, and mortality in various age groups. Br Heart J. 1971; 33: 81-87. Web site. http://heart.bmj.com/con-tent/33/supplement/81.long. Accessed March 19, 2016.
Corone P, Doyon F, Gaudeau S, et al. Natural history of ven-tricular septal defect. A study involving 790 cases. Circulation. 1977; 55(6): 908-915. Web site. http://circ.ahajournals.org/con-tent/55/6/908.full.pdf. Accessed March 19, 2016.
Chaudhry TA, Younas M, Baig A. Ventricular Septal defect and associated complications. JPMA. 2011; 61(10): 1001-1004. Web site. http://jpma.org.pk/full_article_text.php?article_id=30 21. Accessed March 19, 2016
Kobayashi J, Koike K, Senzaki H, et al. Correlation of ana-tomic and hemodynamic features wtih aortic valve leaflet defor-mity in doubly committed subarterial ventricular septal defect. Heart Vessels. 1999; 14(5): 240-245. doi: 10.1007/BF01747853
Tomita H, Arakaki Y, Ono Y, Yamada O, Yagihara T, Echigo S. Imbalance of cusp width and aortic regurgitation associated with aortic cusp prolapse in ventricular septal defect. Jpn Circ J. 2001; 65(6): 500-504. doi: 10.1253/jcj.65.500
Chiu SN, Wang JK, Lin MT, et al. Aortic valve prolapse associated with outlet-type ventricular septal defect. Ann Tho-rac Surg. 2005; 79(4): 1366-1371. doi: 10.1016/j.athorac-sur.2004.10.012
Pongiglione G, Freedom RM, Cook D, Rowe RD. Mecha-nism of acquired right ventricular outflow tract obstruction in patients with ventricular septal defect: an angiocardiography study. Am J Cardiol. 1982; 50(4): 776-780. doi: 10.1016/0002- 9149(82)91233-4
Zielinsky P, Rossi M, Haertel JC. Subaortic fibrous ridge and ventricular septal defect: role of septal malalignment. Circula-tion. 1987; 75(6): 1124-1129. doi: 10.1161/01.CIR.75.6.1124
Gabriel HM, Heger M, Innerhofer P, et al. Long-term out-come of patients with ventricular septal defect considered not to require surgical closure during childhood. J Am Coll Cardiol. 2002; 39(6): 1066-1071. doi: 10.1016/S0735-1097(02)01706-0
Mehta AV, Goenka S, Chidambaram B, Hamati F. Natural history of isolated ventricular septal defect in the first five years of life. Am J Cardiol. 2000; 93(4): 136-138. Web site. http:// europepmc.org/abstract/med/10754804. Accessed March 19, 2016.
Otterstad JE, Erikssen J, Michelsen S, Nitter-Hauge S. Long-term follow-up in isolated ventricular septal defect considered too small to warrant operation. Circulation. 1990; 228(4): 305- 309. doi: 10.1111/j.1365-2796.1990.tb00237.x
Kazmi U, Sadiq M, Hyder SN. Pattern of ventricular sep-tal defects and associated complications. J Coll Physicians Surg Pak. 2009; 19(6): 342-345. Web site. http://www.jcpsp.pk/ar-chive/2009/Jun2009/04.pdf. Accessed March 19, 2016.
Sadiq M, Roshan B, Khan A, Latif F, Bashir I, Sheikh SA. Pediatric heart disease in Pakistan - epidemiological data on 6620 patients. Pak Paed J. 2001; 25: 63-70.
Lue HC, Sung TC, Hou SH, et al. Ventricular septal defect in Chinese with aortic valve prolapse and aortic regurgitation. Heart Vessels. 1981; 2(2): 111-116. doi: 10.1007/BF02059965
Brauner R, Birk E, Blieden L, Sahar G, Vidne BA. Surgical management of ventricular septal defect with aortic valve pro-lapse: clinical considerations and results. Eur J Cardiothoracic Surg. 1995; 9(6): 315-319. doi: 10.1016/S1010-7940(05)80189-7
Glen S, Burns J, Bloomfield P. Prevalence and development of additional cardiac abnormalities in 1448 patients with con-genital ventricular septal defects. Heart. 2004; 90(11): 1321- 1325. doi: 10.1136/hrt.2003.025007
Shah P, Singh WS, Rose V, et al. Incidence of bacterial endo-carditis in ventricular septal defect. Circulation. 1966; 34: 127- 131. doi: 10.1161/01.CIR.34.1.127
Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Heart Research (HROJ) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.