Spontaneous closure of a ventricular septal defect after banding of the pulmonary artery

Edgett, Joseph W.; Nelson, William P.; Hall, Robert J.; Jahnke, Edward J.; Aaby, Gene V.

doi:10.1016/0002-9149(68)90212-9

Cited by 22 publications

(4 citation statements)

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“…[13][14][15] Although the incidence of spontaneous closure of a small VSD in children surviving infancy may well be in the range of 25 to 30%, the incidence of closure of a large VSD must be very low. Thus, despite the theoretical possibility that this may occur, none of the 78 patients in this series who survived the first year of life has undergone spontaneous closure of his VSD.…”

Section: Discussionmentioning

confidence: 99%

Banding of the Pulmonary Artery

et al. 1971

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The results of banding of the pulmonary artery in 111 children with cardiac malformations associated with excessive pulmonary blood flow are presented. Thirty-three of these children died, eleven either of late band complications or after a corrective operation. Patients with ventricular septal defect represent the largest group of malformation among the 111 patients.The overall mortality for banding in patients with isolated ventricular septal defect is 10%, as compared to 36% in patients with ventricular septal defect complicated by an associated lesion. In all infants with ventricular septal defect banded under age 3 months the mortality is 59%, as compared to a mortality of 21% in those banded after age 3 months and only 7% if banded after age 1 year. The overall mortality figures for pulmonary arterial banding have not changed appreciably since 1966; future improvement in banding mortality will depend on improved postoperative management of these infants.Serial hemodynamic studies in patients banded under the age of 2 years have shown a fall in the pulmonary resistance toward normal, with none showing a progression of pulmonary vascular disease. In several patients thickening of the pulmonary valve occurred as a complication of banding.

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Section: Discussionmentioning

confidence: 99%

Banding of the Pulmonary Artery

et al. 1971

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“…In patients with complex heart defects, ventricular septal defect (VSD) is important in maintaining appropriate intra-cardiac shunt; we have recommended that such VSDs are named physiologically advantageous VSD [2]. Spontaneous closure of isolated VSDs was well documented in the 1960s and 1970s [3][4][5][6][7][8]; yet, closure of physiologically advantageous VSDs was not adequately documented in prior studies [2]. The author initially witnessed spontaneous closure of physiologically advantageous VSDs in two children, one with tricuspid atresia and the other with double outlet right ventricle [2].…”

Section: Physiologically Advantageous Ventricular Septal Defectsmentioning

confidence: 99%

Evolution of Pediatric Cardiology over the Last 50 Years - Part IV

Syamasundar¹

2021

Int J Clin Cardiol

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Check for updatesphysiologically advantageous VSDs occurs as often as in isolated VSDs. The mechanisms of closure is also similar to that seen in isolated VSDs. VSD closures were documented to take place in utero, during infancy, childhood, and adolescence and continue through adulthood. It was concluded that there is a great natural tendency for spontaneous closure of VSDs whether it be an isolated defect or is a component of a complex heart defect [10][11][12][13][14][15][16].Spontaneous closure of VSD in children with tricuspid atresia and normally related great arteries (Type I) produces decreased pulmonary blood flow and requires surgical intervention earlier than otherwise needed. We recommended that a Blalock-Taussig (BT) shunt (preferably on the left side) is carried out instead of a Glenn anastomosis (the concept of bidirectional Glenn has not yet been crystallized as of that time) because VSD closure following Glenn will result in no blood flow into the left pulmonary artery (Figure 3). If further palliation is required prior to Fontan procedure, a BT shunt on the right side, Glenn anastomosis, or enlargement of the VSD may be entertained. In subjects with tricuspid atresia and transposition of the great arteries (Type II), VSD closure produces left ventricular outflow obstruction. Therefore, it is highly important that the size of the VSD is appraised before planning for Fontan. If the VSD is small, enlarging the VSD surgically or bypassing the VSD and the right ventricle via a pulmonary artery-to-ascending aorta anastomosis (Damus-Kaye-Stansel) or by a left ventricle-descending aorta conduit (Figure 4) should be considered [10][11][12][13][14]. In addition to tricuspid atresia and double outlet right

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“…[12][13][14][15] Even defects large enough to produce congestive heart failure or require pulmonary artery banding in infancy have been reported to close naturally. 3,6,[14][15][16][17][18][19][20][21] Such occurrences in isolated VSDs are clearly beneficial to the patients with resultant abatement of symptoms. In some complex cardiac lesions, however, an open VSD to maintain adequate intracardiac shunting is essential for patient survival; these have been named physiologically advantageous ventricular septal defects.…”

Section: Introductionmentioning

confidence: 99%

The Ventricular Septal Defect in Tricuspid Atresia: Its Natural History and Surgical Importance

Rao

1983

Ann Saudi Med

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We have previously reported anatomic and functional closure of ventricular septal defects (VSDs) in tricuspid atresia. To study this phenomenon further, clinical, angiographic, and pathologic findings in 40 consecutive cases of tricuspid atresia were reviewed. In 14 of these patients, there was evidence of closure of the VSD; in eight it was complete and in the other six partial. Eleven of these VSD closures occurred in type 1 (without transposition) patients and three among type II (with transposition). Progressive cyanosis, increasing polycythemia and/or disappearance of a previously heard murmur were observed in all patients; these signs were more conspicuous in complete than in partial closure. The incidence of closure of VSD in this lesion was 35 percent but when tricuspid atresia patients without VSD are excluded, the incidence increases to 42 percent. Progressive muscular "encroachment" of the margins of the VSD with subsequent fibrosis and covering by endocardial proliferation is the most likely mechanism of closure. Previous surgical shunts played no role in VSD closure. For initial palliation, a Blalock-Taussig shunt (preferably on the left side) is recommended in preference to a Glenn anastomosis, because the latter may leave the left pulmonary circuit without blood supply if the VSD closes. If further palliation is required prior to a Fontan type of operation, a Blalock-Taussig shunt on the right side, Glenn anastomosis or enlargement of VSD could be performed. In type II patients, a large and non-restrictive VSD is essential for survival following a Fontan operation. Therefore, the size of the VSD should be evaluated prior to and at the time of surgical correction. If the VSD is small in type II cases, complete bypass of the VSD and right ventricle either by a pulmonary artery-to-ascending aorta or left ventricle-to-descending aorta conduit should be performed. This is preferable to resection of the ventricular septum or creation of an aortopulmonary window proximal to pulmonary artery banding.

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Spontaneous closure of a ventricular septal defect after banding of the pulmonary artery

Cited by 22 publications

References 10 publications

Banding of the Pulmonary Artery

Banding of the Pulmonary Artery

Evolution of Pediatric Cardiology over the Last 50 Years - Part IV

The Ventricular Septal Defect in Tricuspid Atresia: Its Natural History and Surgical Importance

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