Natural history of prenatal isolated muscular ventricular septal defects

Erol, Onur; Şevket, Osman; Keskın, Seda; Yazicioglu, H. F.; Gül, Ahmet

doi:10.5152/jtgga.2014.0012

Cited by 22 publications

(24 citation statements)

References 13 publications

(11 reference statements)

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“…Further studies on fetal anthropometry and haemodynamics are necessary to provide insight into the relationship between cardiovascular malformations and low birth weight. In addition, reports of SC rates in utero are highly variable (3–46.1%), with average defects measuring 1.5–2 mm in size [16, 20, 26, 28]. In the present research, this compared with 19.1% SC rate in utero.…”

Section: Discussionsupporting

confidence: 42%

Prediction of spontaneous closure of isolated ventricular septal defects in utero and postnatal life

Song

et al. 2016

BMC Pediatr

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BackgroundVentricular septal defect (VSD) is a highly prevalent fetal congenital heart defect, which can become spontaneously closed during infancy. The current study aims to characterize fetal VSDs that were subsequently spontaneously closed in the first 2 years of life in eastern China.MethodsBetween January 2011 and December 2013, 257 fetal patients diagnosed with isolated VSD by fetal echocardiography at Nanjing Maternity and Child Health Care Hospital, China, were enrolled in the study. Subjects were divided into three groups: group 1 = persistent VSD; group 2 = closed after birth; group 3 = closed during gestation. Fetal echocardiography data, physical features at birth and follow-up outcomes for 2 years were compared to identify factors contributing to spontaneous closure (SC) of VSD. A predictive formula was applied to patients admitted to hospital in the first quarter of 2014 (n = 23) for validation.ResultsSC occurred in 42.8% patients. Birth weight (3.095 ± 0.774, 3.174 ± 0.535, 3.499 ± 0.532 kg in groups 1, 2 and 3, respectively) and defect diameter (3.422 ± 0.972, 2.426 ± 0.599, 2.292 ± 0.479 mm, in groups 1, 2 and 3, respectively) showed statistically significant differences between the three groups (P = 0.004 and P = 0.000, respectively). Receiver operating characteristic (ROC) curves identified cut-off value for the defect diameter as 2.55 mm, and logistic regression analysis identified the SC probability = (1 + exp -[-2.151 − 0.716*birth weight + 1.393*diameter])-1. Results indicated that male fetuses, full-term birth, muscular VSD, and defects without blood flow crossing the septum, have higher incidence of SC.ConclusionsThe major determinants of SC of isolated VSD are birth weight and diameter of the defect. In addition, VSD location may also affect the SC incidence.

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Section: Discussionsupporting

confidence: 42%

Prediction of spontaneous closure of isolated ventricular septal defects in utero and postnatal life

Song

et al. 2016

BMC Pediatr

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“…In contrast, Beerman et al reported that of 87 membranous VSDs, only four patients (5%) had spontaneous closure of the defect (17). A recent study of fetal echocardiography showed a high incidence of spontaneous closure of muscular VSD during the fi rst year of life, and 7% (3 of 44) of muscular VSD closed spontaneously in utero (3). Th e prevalence of spontaneous closure of muscular VSD is not completely understood, but may be related to the inherent structure of the ventricular septum (more complex embryotic origin of the membranous compared to the muscular part) (4), the growth and hypertrophy of surrounding muscular septum in the uterus (3), or a protracted normal closing process in the interventricular septum, because most trabecular septal defects in the neonate period resulted from incomplete trabecular coalescence (2).…”

Section: Incidence Of Spontaneous Vsd Closurementioning

confidence: 95%

“…Several studies have demonstrated that spontaneous VSD closure occurs more frequently in small defects than large ones (3,7,11,12). It was reported that the defects with diameter ≤3 mm (3), <4 mm (12) or <5 or 6 mm (7) were more likely to close spontaneously.…”

Section: Incidence Of Spontaneous Vsd Closurementioning

confidence: 99%

“…It was reported that the defects with diameter ≤3 mm (3), <4 mm (12) or <5 or 6 mm (7) were more likely to close spontaneously. Th e size of the defect has also been suggested to aff ect the incidence of spontaneous VSD closure, particularly in muscular VSD (2,3,13). Th e incidence of closure varies with the site of the defect, with a closure rate of 83% in the anterior, 84% in the apical, and 89% in the mid-ventricular septum (13).…”

Section: Incidence Of Spontaneous Vsd Closurementioning

confidence: 99%

“…Age has been found to have a significant infl uence on the incidence of spontaneous VSD closure, whereas gender seems less likely to aff ect the incidence. Although spontaneous VSD closure can occur at any agegestation, infancy, childhood, adolescence, and adulthood (1)-it occurs most commonly during the fi rst 6 months of life (2), during the fi rst year (3,4), or soon after the fi rst year of life (5). Afterward, the occurrence of closure declines progressively and occurs less commonly after the age of 10 (5).…”

Section: Incidence Of Spontaneous Vsd Closurementioning

confidence: 99%

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A Review of Spontaneous Closure of Ventricular Septal Defect

Zhang¹,

Ko²,

Guileyardo³

et al. 2015

Baylor University Medical Center Proceedings

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516Ventricular septal defect (VSD) is the most common congenital heart malformation and can be detected during the prenatal and postnatal period, in childhood, and in adulthood. Spontaneous closure of VSD can be determined through a variety of methods-echocardiography, Doppler color flow imaging, angiography, auscultation, and cardiac catheterization-and can be proven by pathological evidence at necropsy. There are two major types of VSD, membranous and muscular, as well as the perimembranous variety, which comprises variable portions of the adjacent muscular septum but lacks the membranous septum. VSD appears either as an isolated cardiac defect without other abnormalities or with several complex malformations. It has long been recognized that VSD can close spontaneously, but the incidence of spontaneous VSD closure is still uncertain. Since necropsy study of the hearts with VSD has rarely been reported, information on morphological features of spontaneous VSD closure remains limited. In addition, the mechanisms for spontaneous VSD closure are not fully understood. Herein, we present a brief review of the incidence of spontaneous VSD closure, morphological characteristics of the closure, and the main mechanisms responsible for the closure. INCIDENCE OF SPONTANEOUS VSD CLOSURETh e incidence of spontaneous ventricular septal defect (VSD) closure varies greatly, depending on the age and gender of subjects at spontaneous closure, the size and site of the defect, the types of defect, as well as the population studied, methods employed, and length of follow-up period. Table 1 presents available data on the incidence of spontaneous VSD closure.Age and gender. Age has been found to have a significant infl uence on the incidence of spontaneous VSD closure, whereas gender seems less likely to aff ect the incidence. Although spontaneous VSD closure can occur at any agegestation, infancy, childhood, adolescence, and adulthood (1)-it occurs most commonly during the fi rst 6 months of life (2), during the fi rst year (3, 4), or soon after the fi rst year of life (5). Afterward, the occurrence of closure declines progressively and occurs less commonly after the age of 10 (5). It has been documented that the incidence of the close increases with age, from 24% at 18 months of age to 50% at 48 months and 75% at 120 months (6). However, in older children, at 3.5 years old, the incidence declines sharply to 44% and then rises to 66% at 7 years and 75% at 10.5 years (6). A similar trend has been found in other reports, which showed 57% (109/190) of cases closed before 3 years of age, 89% (169/190) closed before 8 years of age (7), and 4% to 10% closed after the age of 17 (8, 9). During adulthood, the incidence of spontaneous VSD closure remarkably declines. One study showed that of 188 adults with VSD, 19 patients' (10%) VSD closed spontaneously between the age of 17 and 45 years, and the incidence of closure was greater in the 17-to 24-year age group than the 25-to 34-year group, the 35-to 44-year group, and the ≥45-year group (8)...

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Prediction of spontaneous closure of ventricular septal defect and guidance for clinical follow‐up

Ren

Song

et al. 2019

Clinical Cardiology

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Aim To predict the spontaneous closure of ventricular septal defect (VSD) and assist pediatrician to manage VSD children. Methods Between January 2008 and December 2016, 132 children diagnosed with isolated VSD by echocardiography were enrolled. All participating children were followed‐up by echocardiography yearly until the closure of VSD or 6 years old. The clinical indicators and echocardiographic parameters of patients were collected. Statistically significant factors were used to establish a Logistic Regression model for predicting spontaneous closure of VSD. Receiver operating characteristic (ROC) analysis was used to assess the specificity and sensitivity of Logistic Regression model. Results Spontaneous closure occurred in 60% of all patients; 57% in perimembranous VSD (p‐VSD) and 64% in muscular VSD (m‐VSD) patients. Initial diagnosis age, defect size, aneurysms tissue of the ventricular membranous septum (ATVMS), pulmonary hypertension (PH), and left ventricular diastolic dimension (LVDD) were statistically significant. Defect size, ATVMS and LVDD were determined by the Logistic Regression model as representative factor. P‐VSD and m‐VSD model had areas under the ROC curves 0.854 and 0.898, respectively. Conclusion We inferred that defect size, ATVMS and LVDD were characteristic and representative predictors for spontaneous closure of VSD. And we summarized the prognostic factors and recommended a follow‐up criteria to assist the pediatrician managing VSD children.

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Natural history of prenatal isolated muscular ventricular septal defects

Cited by 22 publications

References 13 publications

Prediction of spontaneous closure of isolated ventricular septal defects in utero and postnatal life

Prediction of spontaneous closure of isolated ventricular septal defects in utero and postnatal life

A Review of Spontaneous Closure of Ventricular Septal Defect

Prediction of spontaneous closure of ventricular septal defect and guidance for clinical follow‐up

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