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Spontaneous closure of perimembranous ventricular septal defect after school age
Author(s) -
Miyake Toshiharu,
Shinohara Tohru,
Fukuda Tsuyoshi,
Ikeoka Megumi,
Takemura Tsukasa
Publication year - 2008
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/j.1442-200x.2008.02642.x
Subject(s) - medicine , shunting , cardiology , cardiac catheterization , heart septal defect , surgery
Background: The number of studies of long‐term follow up to adolescence is very low on spontaneous closure (SC) of perimembranous ventricular septal defects (P‐VSD) in children not undergoing surgical closure because of small left‐to‐right shunting. Methods: Seventy patients with a P‐VSD with pulmonary‐to‐systemic flow ratio (Qp/Qs) < 1.7 underwent cardiac catheterization at the age of 2–10 years (mean, 5.1 years). Excluding 22 patients who dropped out by 15 years, 48 were selected. Qp/Qs ranged from 1.00 to 1.68 (mean, 1.17). The average follow‐up period of 37 patients excluding the SC patients was 17.8 years. They were classified according to Qp/Qs into three groups: group I, 1.4 ≤ Qp/Qs < 1.7; group II, 1.2 ≤ Qp/Qs < 1.4; and group III, 1.0 ≤ Qp/Qs < 1.2. Results: SC occurred in 11 patients (23%). SC rates in group I and II were lower than those in group III (I, 0/8 0%; II, 1/10 10%; III, 10/30 33%). In 23 patients (48%), an aneurysm of the ventricular membranous septum (AVMS) was detected, but no significant relationship was found between the presence of AVMS and SC rate. Conclusions: 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 ≥ 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.