Institute of Pediatrics, First Affiliated Bethune Hospital, Jilin University, Changchun 130021, China.
J Thorac Dis. 2013 Oct;5(5):600-4. doi: 10.3978/j.issn.2072-1439.2013.09.05.
Ventricular septal defect (VSD) is the most frequent type of congenital heart disease. Conventional methods to evaluate VSD size and severity are both invasive and cumbersome to perform. We investigated whether the ratio between the diameter of the defect and the aortic root diameter (DVSD/DAR) would accurately reflect the degree of shunted blood and the severity of VSD in children with perimembranous VSD.
We recruited 987 children with perimembranous VSD (pmVSD) and used color Doppler echocardiography to calculate DVSD/DAR. 987 healthy children were recruited as control group. The pmVSD group was further stratified into four groups according to age (1 to 4 y) and again into four groups according to the DVSD/DAR ratio: children whose DVSD/DAR was 1/5 to <1/4, 1/4 to <1/3, 1/3 to 1/5, or 1/2 to <2/3 were assigned to groups A, B, C, and D, respectively. Height, weight, infection scores and systemic-pulmonary circulation ratio (QP/QS ratio) were compared among groups A, B, C and D. Then the relationship between the DVSD/DAR ratio and height, weight, QP/QS ratio, infection score were analysed by linear regression analysis.
Compared to age-matched children without VSD (the controls), the mean height and weight of children in the pmVSD group were lower, and heights and weights were negatively correlated with the DVSD/DAR ratio. This ratio was significantly reduced in groups C and D compared to control group (both P<0.05). Infection scores of groups A and B were significantly higher only in the one-year-old subgroup, but were significantly higher in groups C and D for all ages compared to the control group (both P<0.05). QP/QS ratio of group C and D were higher than group A and group B (all P<0.05). Moreover, QP/QS ratio of group D for all ages were more than 2. In addition, linear regression analysis revealed that the DVSD/DAR ratio negatively correlated with height and weight and positively correlated with the QP/QS ratio and infection score.
Our results suggest that the DVSD/DAR ratio accurately reflects the growth and pulmonary infection rates in children with pmVSD. This ratio, therefore, may be a useful additional reference index to predict the consequences of pmVSD.
室间隔缺损（VSD）是最常见的先天性心脏病类型。评估 VSD 大小和严重程度的传统方法既具有侵入性，又繁琐。我们研究了膜周部 VSD 患儿的 VSD 直径与主动脉根部直径比值（DVSD/DAR）是否能准确反映分流量和 VSD 严重程度。
我们招募了 987 例膜周部 VSD（pmVSD）患儿，使用彩色多普勒超声心动图计算 DVSD/DAR。招募 987 例健康儿童作为对照组。pmVSD 组根据年龄（1 至 4 岁）进一步分为 4 组，根据 DVSD/DAR 比再分为 4 组：DVSD/DAR 为 1/5 至 <1/4、1/4 至 <1/3、1/3 至 1/5 和 1/2 至 <2/3 的患儿分别归入 A、B、C 和 D 组。比较 A、B、C 和 D 组患儿的身高、体重、感染评分和体肺循环比（QP/QS 比）。然后用线性回归分析 DVSD/DAR 比与身高、体重、QP/QS 比、感染评分的关系。
与无 VSD 的同龄患儿（对照组）相比，pmVSD 组患儿的平均身高和体重较低，身高和体重与 DVSD/DAR 比呈负相关。与对照组相比，C 组和 D 组的比值显著降低（均 P<0.05）。A 组和 B 组的感染评分仅在 1 岁亚组中显著升高，但 C 组和 D 组在所有年龄组中均显著高于对照组（均 P<0.05）。C 组和 D 组的 QP/QS 比值高于 A 组和 B 组（均 P<0.05）。此外，D 组所有年龄组的 QP/QS 比值均大于 2。此外，线性回归分析显示，DVSD/DAR 比与身高和体重呈负相关，与 QP/QS 比和感染评分呈正相关。
我们的结果表明，DVSD/DAR 比能准确反映 pmVSD 患儿的生长和肺部感染率。因此，该比值可能是预测 pmVSD 后果的有用附加参考指标。
