Erdem Sevcan, Ozbarlas Nazan, Küçükosmanoğlu Osman, Poyrazoğlu Hakan, Salih Orhan Kemal
Department of Pediatric Cardiology, Çukurova University, Adana, Turkey.
Turk Kardiyol Dern Ars. 2012 Jan;40(1):22-5. doi: 10.5543/tkda.2012.01679.
We evaluated long-term follow-up results and prognosis of pediatric patients with isolated ventricular septal defects (VSD).
The study included 799 patients (368 girls, 431 boys; mean age at diagnosis 24.3±37.4 months; median 6 months) who were monitored by the pediatric cardiology department for VSD. The mean follow-up period was 32.8±30.3 months (median 20 months).
The VSDs were classified as perimembranous (n=610, 76.4%), muscular (n=171, 21.4%), doubly committed subarterial (n=10, 1.3%), and multiple (n=8, 1%). Spontaneous closure rates were 42.7%, 13.1%, and 25% in muscular, perimembranous, and multiple VSDs, respectively, which corresponded to a mean age of 18.6±19.9 months (median 12 months) in muscular and 30.2±33.7 months (median 14.5 months) in perimembranous VSDs. Before 2 years of age, 78.1% of muscular and 58.6% of perimembranous VSDs underwent spontaneous closure. Of 256 defects (32%) that required surgical closure, 91.4% were of perimembranous location. The mean age at surgery was 38.8±49.1 months (median 11 months) for muscular, and 43.7±40.9 months (median 24 months) for perimembranous defects. During the follow-up period, the following complications were noted: aortic valve prolapse (0.7%), aortic regurgitation (0.6%), left ventricle-to-right atrium shunt (2.6%), subaortic ridge (3.7%), and infundibular stenosis (1.2%). Aortic regurgitation developed in eight patients (3.7%) after surgical closure.
Our data on the natural course and prognosis of VSDs may be of relevance with respect to patients' age, defect type, and complications encountered in the follow-up period.
我们评估了孤立性室间隔缺损（VSD）患儿的长期随访结果及预后情况。
本研究纳入了799例患者（368例女孩，431例男孩；诊断时平均年龄24.3±37.4个月；中位数为6个月），这些患者由儿科心脏病科进行VSD监测。平均随访期为32.8±30.3个月（中位数为20个月）。
VSD分为膜周部（n = 610，76.4%）、肌部（n = 171，21.4%）、双动脉下型（n = 10，1.3%）和多发型（n = 8，1%）。肌部、膜周部和多发型VSD的自然闭合率分别为42.7%、13.1%和25%，肌部VSD自然闭合的平均年龄为18.6±19.9个月（中位数为12个月），膜周部VSD为30.2±33.7个月（中位数为14.5个月）。2岁前，78.1%的肌部VSD和58.6%的膜周部VSD实现了自然闭合。在需要手术闭合的256处缺损（32%）中，91.4%为膜周部缺损。肌部缺损手术时的平均年龄为38.8±49.1个月（中位数为11个月），膜周部缺损为43.7±40.9个月（中位数为24个月）。在随访期间，观察到以下并发症：主动脉瓣脱垂（0.7%）、主动脉反流（0.6%）、左心室向右心房分流（2.6%）、主动脉下嵴（3.7%）和漏斗部狭窄（1.2%）。8例患者（3.7%）在手术闭合后出现主动脉反流。
我们关于VSD自然病程和预后的数据可能与患者年龄、缺损类型以及随访期间遇到的并发症有关。
