Van Hare G F, Soffer L J, Sivakoff M C, Liebman J
Am Heart J. 1987 Sep;114(3):606-14. doi: 10.1016/0002-8703(87)90759-9.
Three hundred eighty-one children with isolated VSD were catheterized from 1960 through 1985, 228 of whom were first catheterized in the first year of life. Defect size was defined by the right-to-left ventricular systolic pressure ratio. Patients with small VSD had a good outcome, with no pulmonary vascular disease. Seventy-five percent of patients with moderate VSDs did not require surgery, and 58% had normal pulmonary artery pressures documented on a second catheterization. Of those patients with large VSDs who underwent serial catheterizations in the first year of life before surgery, 62% had partial closure, and pulmonary vascular resistance rose in 21%. None developed pulmonary vascular disease after surgery. Fewer large-restrictive than nonrestrictive VSDs required surgery in infancy (12% vs 51%; p less than 0.005), and more closed enough to never require surgery (62% vs 27%; p less than 0.005, chi square). Surgery is rarely necessary for patients with small and moderate-sized VSDs in the first year and is usually never necessary because of the expected decrease in size. Few patients with large-restrictive VSDs have an increase in pulmonary vascular resistance, many defects decrease in size, and most patients never need surgery. Patients who have a nonrestrictive VSD have an excellent prognosis with appropriate management.
1960年至1985年间，对381例单纯室间隔缺损患儿进行了心导管检查，其中228例在出生后第一年内首次接受心导管检查。缺损大小通过右心室与左心室收缩压比值来定义。小型室间隔缺损患者预后良好，无肺血管疾病。中度室间隔缺损患者中，75%不需要手术，58%在第二次心导管检查时记录到肺动脉压力正常。在出生后第一年内手术前接受系列心导管检查的大型室间隔缺损患者中，62%出现部分闭合，21%肺血管阻力升高。术后无一例发生肺血管疾病。婴儿期需要手术的大型限制性室间隔缺损患者比非限制性室间隔缺损患者少（12%对51%；p<0.005），完全闭合以至于无需手术的比例更高（62%对27%；p<0.005，卡方检验）。小型和中型室间隔缺损患者在出生后第一年内很少需要手术，而且由于预期缺损会缩小，通常根本不需要手术。大型限制性室间隔缺损患者中很少有肺血管阻力增加的情况，许多缺损会缩小，大多数患者根本不需要手术。非限制性室间隔缺损患者经适当治疗后预后极佳。
