ACTA FAC. MED. NAISS. 2006; 23 (1): 25-29

   Original article

THE NATURAL HISTORY OF MUSCULAR VENTRICULAR SEPTAL DEFECTS

Ljiljana Pejcic1, Bojko Bjelakovic1, Biljana Miljkovic2, Radmila Mileusnic1, Gordana Grujic3, Ivica Pejcic4

1Clinic of Pediatrics, Clinical Center Nis
2Clinic of Gynecology, Clinical Center Nis
3Primary Helth Care Center Nis
4Clinic of Oncology, Clinical Center Nis

     SUMMARY

    Ventricular septal defect (VSD) is the most frequently diagnosed congenital heart defect. The prognosis is usually good as it has spontaneous closure evolution, especially small muscular VSDs. The aim of this study was to determine the natural history of isolated muscular VSDs including frequency of spontaneous closure in relation to location in the muscular septum and age at the time of closure.
    Doppler color flow mapping studies were performed to define ventricular septal defect anatomy, location and evolution. Of approximately 19.500 live births in the region during last 6 years, VSD was identified as isolated congenital heart lesion in 87 infants (incidence 5.8 per 1,000 live births). Fortysix infants (53%) had a muscular VSD. Thirty of 46 were followed up for a minimum of 1 year.
    Spontaneous closure occurred in 17 of 30 cases (56.7%). The time of spontaneous closure ranged from 1 to 42 months and it was most commonly recorded during the first 6 months after birth. In the 6th month, 1st year and 18th month, spontaneous closure occurred in 11 (36.7%), 14 (46.7%) and 16 (53.3%) cases, respectively. It was registered in all cases except one within the first 18 months; the other defect closed in the 42nd month. It was remarkable that spontaneous closure was seen in 15 of 21 cases (71.4%) with apical VSD and 2 of 7 cases (28.6%) with trabecular VSD.
    In conclusion, the frequency of spontaneous closure is very high in the first 6 months, especially within the first four years of life. Because of the high closure rate of muscular VSDs especially apical ones, it is recommendable to detect them early using color flow imaging and follow up patients up to spontaneous closure.

    Key words: muscular ventricular septal defects, rate of spontaneous closure, color flow imaging