Ramaciotti C, Keren A, Silverman N H
Am J Cardiol. 1986 Feb 1;57(4):268-72. doi: 10.1016/0002-9149(86)90903-3.
Records were reviewed of 247 patients found to have isolated perimembranous ventricular septal defect (VSD) on cross-sectional echocardiography. Patients were separated into 2 groups: those in whom a perimembranous ventricular septal aneurysm (VSA) was associated with the VSD (group A, 77% of patients) and those in whom a VSA was not present (group B, 23%). The VSD was assessed by clinical (125 in group A, 24 in group B) and hemodynamic criteria (65 in group A, 33 in group B). The median follow-up period was 27 months (range 3 months to 25 years). In group A, the VSD closed spontaneously in 11% of the patients, improved clinically in 33% and required surgical closure in 11%. In group B, the VSD closed spontaneously in only 2%, improved clinically in 16% and required surgical closure in 47%. When considering larger VSDs only, 28% required surgery in group A, whereas 84% required surgery in group B (p less than 0.001). The VSA was found at the first echocardiographic examination in 94% of the studies. Thus, VSA is found in a large proportion of patients with perimembranous VSD. It occurs as an early phenomenon and is an important mechanism of closure. The presence of a VSA appears to confer a more favorable prognosis in perimembranous VSD except in patients with Down's syndrome.
回顾了247例经横断面超声心动图检查发现单纯膜周部室间隔缺损（VSD）患者的记录。患者被分为两组：膜周部室间隔瘤（VSA）与VSD相关的患者（A组，占患者的77%）和不存在VSA的患者（B组，占23%）。通过临床标准（A组125例，B组24例）和血流动力学标准（A组65例，B组33例）对VSD进行评估。中位随访期为27个月（范围3个月至25年）。在A组中，11%的患者VSD自发闭合，33%临床症状改善，11%需要手术闭合。在B组中，仅2%的患者VSD自发闭合，16%临床症状改善，47%需要手术闭合。仅考虑较大的VSD时，A组28%需要手术，而B组84%需要手术（p<0.001）。在94%的研究中，首次超声心动图检查时发现了VSA。因此，在大部分膜周部VSD患者中发现了VSA。它作为一种早期现象出现，是闭合的重要机制。除唐氏综合征患者外，VSA的存在似乎赋予膜周部VSD更有利的预后。
