Spontaneous closure of perimembranous ventricular septal defect after school age

Miyake, Toshiharu; Shinohara, T; Fukuda, Tsuyoshi; Ikeoka, Megumi; Takemura, Tsukasa

doi:10.1111/j.1442-200x.2008.02642.x

Cited by 21 publications

(10 citation statements)

References 18 publications

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“…Muscular VSDs tend to close in 80% cases early in life,21 22 25 32–36 a frequency that is at least twice the frequency of spontaneous closure for perimembranous VSDs 25. Spontaneous closure may occur up to age 6 years25 or beyond school age for perimembranous VSDs 23. Interestingly, the presence of partially occluding accessory tissue is not predictive of spontaneous closure 23…”

Section: Resultsmentioning

confidence: 99%

Controversies in the definition and management of insignificant left-to-right shunts

Cantinotti

Assanta

Murzi

et al. 2013

Heart

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Haemodynamically insignificant left-to-right shunts are frequently discovered when screening for congenital heart disease, resulting in significant economic and psychosocial impact. A literature search was performed within the National Library of Medicine using the keywords small/insignificant/silent atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA) and patent foramen ovale (PFO). The search was refined by adding the keywords definition, classification and follow-up. Our analysis revealed significant heterogeneity in the evaluation and management of innocent left-to-right shunts. The definitions for small defects vary greatly, making it difficult to distinguish between physiologic and pathologic lesions (eg, a PFO vs a true ASD). Most small defects will partially or completely resolve spontaneously early in life. If spontaneous resolution does not occur, the risk for long-term complications (such as embolic events and endocarditis) is low but poses several practical and ethical issues: immediate discharge versus long-term follow-up, duration and frequency of follow-up, and content and method of discussions with the parents. Additionally, there is controversy pertaining to treatment for PDAs and VSDs, particularly among interventional cardiologists, even though risk/benefit analyses are lacking. Standards and guidelines using consensus opinion for the management of insignificant left-to-right shunts are needed to address the heterogeneity in diagnosis and management as well as use of resources, ethical and psychosocial issues.

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Section: Resultsmentioning

confidence: 99%

Controversies in the definition and management of insignificant left-to-right shunts

Cantinotti

Assanta

Murzi

et al. 2013

Heart

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“…In most cases, the constructive tissue of AMS is usually derived from the tricuspid valve but not from the septal membrane itself (17). In spite of the association between VSD and AMS, Miyake et al suggested that there was no relation between the closure and AMS because AMS was detected in 48% (23 of 48) of patients with perimembranous VSD, and of the 23 defects with AMS, only 4 (17%) closed spontaneously (30). Some authors believe that perimembranous VSD is closed by tricuspid pouch.…”

Section: Mechanisms Responsible For Spontaneous Vsd Closurementioning

confidence: 99%

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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“…Complete or partial closure may occur by adhesion of the septal leaflet of the tricuspid valve to the edge of the defect, often with formation of an aneurysm. The prevalence of an AMS in patients with a membranous VSD is reported by the earlier-mentioned studies of Miyake et al and Neumayer et al to be as high as 48 % during childhood [3] and 10 % above 17 years of age [4].…”

Section: Discussionmentioning

confidence: 83%

“…In membranous VSDs spontaneous closure is frequent. During childhood, 23 % (0-33 %) of the small membranous VSDs close spontaneously [3] and after the age of 17, a smaller portion of 4-10 % close spontaneously [4,5]. Complete or partial closure may occur Electronic supplementary material The online version of this article…”

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confidence: 99%

A ventricular septal defect with a giant appendiform aneurysm of the membranous septum

Cozijnsen

Maas

et al. 2012

Neth Heart J

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We report a case of a 39-year-old female with a ventricular septal defect (VSD) and a giant appendiform aneurysm of the membranous septum, illustrated by echocardiography and magnetic resonance imaging. From the literature a short review of the prevalence of spontaneous closure of VSDs together with the possible complications of persisting VSDs is presented. Since patients stay at risk in later years, follow-up at regular intervals is advised.Keywords Ventricular septal defect . Aneurysm membranous septum . Spontaneous closure . Echocardiography . Magnetic resonance imaging CaseA 39-year-old female presented to the hospital with palpitations. She was diagnosed at birth with a ventricular septal defect (VSD) for which she received cardiological followup until the age of five. On physical examination a late systolic-early diastolic murmur was heard. The electrocardiogram showed sinus rhythm with an incomplete right bundle branch block. On Holter monitoring normal sinus rhythm with sporadic premature atrial and ventricular complexes was seen. The palpitations subsided spontaneously. In the diagnostic workup, echocardiography showed a small isolated VSD with a diameter of 6 millimeter (mm) and a giant aneurysm of the membranous septum (AMS), with a 25 mm long tube, protruding into the right ventricle (RV) with a terminal diameter of 8 mm (Figs. 1a, b, 2a) (also movie). We could not detect a left-to-right (L-R) shunt (Figs. 1c, 2b). Apparently the aneurysm has closed the VSD. There was no obstruction of the right ventricular outflow tract. Otherwise no abnormalities were found on echocardiography, especially no signs of left ventricular (LV) volume overload, pulmonary hypertension or valvular incompetence. Additionally magnetic resonance imaging (MRI) was performed confirming the VSD and the giant appendiform AMS in an otherwise completely normal heart. (Fig. 3) DiscussionIsolated VSDs are the most common congenital heart malformation at birth, around 30-40 %, if bicuspid aortic valve is not counted [1]. VSD is the most frequent main diagnosis in the CONCOR database, the Dutch registry of adults with congenital heart disease [2]. In membranous VSDs spontaneous closure is frequent. During childhood, 23 % (0-33 %) of the small membranous VSDs close spontaneously [3] and after the age of 17, a smaller portion of 4-10 % close spontaneously [4,5]. Complete or partial closure may occur Electronic supplementary material The online version of this article

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Spontaneous closure of perimembranous ventricular septal defect after school age

Abstract: SC occurred in 23% of patients with a P-VSD of Qp/Qs < 1.7 up to adolescence. But a P-VSD of Qp/Qs >or= 1.2 showed no tendency to close spontaneously. The factor most influencing SC of P-VSD after school age seemed to be the shunt ratio.

Cited by 21 publications

References 18 publications

Controversies in the definition and management of insignificant left-to-right shunts

Controversies in the definition and management of insignificant left-to-right shunts

A Review of Spontaneous Closure of Ventricular Septal Defect

A ventricular septal defect with a giant appendiform aneurysm of the membranous septum

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