Beramendi Calero J R, Pastor Menchaca E, Galdeano Miranda J M, Beltrán de Heredia P, Pérez García J, Alcíbar Villa J, Rodrigo Carbonero D, Cabrera Duro A
Cardiología Pediátrica, Hospital Infantil Cruces, Vizcaya.
An Esp Pediatr. 1998 Sep;49(3):284-8.
The aim of this study was to evaluate the prevalence and the follow-up in the long run of ventricular septal defect in the neonatal period.
222 patients with ventricular septal defect from a total amount of 30,840 newborns admitted to our Hospital were evaluated between January 1991 and December 1996 (The incidence accounts for 7.19 per 1,000 newborns). 123 of these patients were males (55.4%) and 99 females (44.6%). The mean age at the time of examination was 3.09 +/- 1.67 days (range from 1 to 11 days). Diagnosis was suspected because of a harsh systolic murmur in 207 cases (93.2%), a malformative syndrome in 10 (4.5%) or polypnea in 5 (2.3%). The study was performed with a Sonos 1000 Echocardiograph device. The mean follow-up period ranged from 1 to 72 months. 10 patients underwent cardiac catheterization (4.5%).
A muscular defect was the common finding in 177 patients (79.7%) whereas 41 patients (18.5%) exhibited a perimembranous defect. The mean size defect was 2.9 +/- 1.2 mm (range 1-10 mm), being smaller in the muscular defects (2.56 +/- 0.68) than in the perimembranous defects (4.33 +/- 1.56) p < 0.001. Spontaneous closure occurred in 176 ventricular septal defects (79.3%), 155 of them corresponding to muscular defects (87.6%) and 18 to perimembranous defects (43.9%). The mean age at the time of spontaneous closure was 9.5 +/- 8.9 months (9.4 +/- 9 months in the muscular defects and 10.3 +/- 4 months in the perimembranous defects). Spontaneous closure occurred by age 6 months in 52% of the patients with ventricular septal defect (54.5% muscular defects, 33.3% perimembranous defects), 12 months in 72.7% (71.2% muscular defects and 83.3% perimembranous defects) and 24 months in 96% (96.1% muscular defects and 94.4% perimembranous defects). 10 patients underwent surgical repair by age 11 +/- 8 months. All of them exhibited perimembranous defects with a mean size 6 +/- 1.5 mm which were tantamount to 24.4% of this group. 3 patients died (1.4%), 2 suffering from trisomy 18 and 1 after cardiac surgical repair.
The most common ventricular septal defects in the neonatal period occur in the region of the muscular septum. The prognosis is favourable. Most of the patients experience spontaneous closure and show a very low mortality rate which is basically related to extracardiac anomalies.
本研究旨在评估新生儿期室间隔缺损的患病率及长期随访情况。
1991年1月至1996年12月期间，对我院收治的30840例新生儿中的222例室间隔缺损患者进行了评估（发病率为每1000例新生儿中有7.19例）。其中男性123例（55.4%），女性99例（44.6%）。检查时的平均年龄为3.09±1.67天（范围为1至11天）。因收缩期粗糙杂音而怀疑诊断的有207例（93.2%），因畸形综合征而怀疑的有10例（4.5%），因呼吸急促而怀疑的有5例（2.3%）。本研究使用Sonos 1000型超声心动图设备进行。平均随访期为1至72个月。10例患者接受了心导管检查（4.5%）。
177例患者（79.7%）的常见表现为肌部缺损，而41例患者（18.5%）表现为膜周部缺损。缺损的平均大小为2.9±1.2毫米（范围为1至10毫米），肌部缺损（2.56±0.68）比膜周部缺损（4.33±1.56）小，p<0.001。176例室间隔缺损（79.3%）发生了自然闭合，其中155例为肌部缺损（87.6%），18例为膜周部缺损（43.9%）。自然闭合时的平均年龄为9.5±8.9个月（肌部缺损为9.4±9个月，膜周部缺损为10.3±4个月）。52%的室间隔缺损患者在6个月龄时发生自然闭合（肌部缺损为54.5%，膜周部缺损为33.3%），72.7%在12个月龄时发生自然闭合（肌部缺损为71.2%，膜周部缺损为83.3%）；96%在24个月龄时发生自然闭合（肌部缺损为96.1%，膜周部缺损为94.4%）。10例患者在11±8个月龄时接受了手术修复。他们均表现为膜周部缺损，平均大小为6±1.5毫米，占该组的24.4%。3例患者死亡（1.4%），2例患有18三体综合征，1例在心脏手术修复后死亡。
新生儿期最常见的室间隔缺损发生在肌间隔区域。预后良好。大多数患者会自然闭合，死亡率很低，主要与心外异常有关。
