Pattern of ventricular septal defects and associated complications.

OBJECTIVE

To determine the frequency of various types of Ventricular Septal Defect (VSD) in local population and their complications.

STUDY DESIGN

Case series.

PLACE AND DURATION OF STUDY

The Paediatric Cardiac Unit of the Children Hospital and Institute of Child Health, Lahore, from January 2006 to December 2007.

METHODOLOGY

All patients aged between one day to 18 years presenting to the unit with isolated VSD during the study period were evaluated using 2-D, continuous wave Doppler and colour Doppler techniques on transthoracic echocardiography. Where necessary, transesophageal echocardiography and/or angiography data was used to further clarify the anatomy.

RESULTS

Of the 854 patients with isolated VSD, 710 were of perimembranous type (83.1%), 100 were muscular type (11.7%), 25 were doubly committed subarterial (DCSA) type (2.9%) and 19 patients were having inlet VSD (2.2%). The mean age was 2.1+3 years. Females were 332 (38.8%) and males were 522 (61.1%). Aortic Valve Prolapse (AVP) was seen in 77 patients (10.8%). The mean age for this subgroup was 5.8+4 years with 54 (70.1%) males and 23 (29.9%) females. Of those, 36 (47.3%) had various degree of aortic regurgitation. Right ventricular outflow tract obstruction of variable severity was found in 4 patients. Two of these patients had echocardiographic evidence of subacute bacterial endocarditis.

CONCLUSION

Perimembranous (PM) VSD is the commonest type of ventricular septal defect presenting to a tertiary care hospital. The incidence of AVP and AR is high (10.8%) and was found almost entirely in perimembranous outlet VSDs rather than DCSA. This observation has special implication in Pakistan where pool of unoperated VSDs is large.