The Natural and Unnatural History of Ventricular Septal Defects Presenting in Infancy: An Echocardiography-Based Review
| Autor: | Rajesh Punn, Claudia Algaze-Yojay, Norman H. Silverman, Kelly Cox |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Heart Defects
Congenital Heart Septal Defects Ventricular Aortic valve congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Heart malformation Heart Ventricles Volume overload First year of life 030204 cardiovascular system & hematology 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Left atrial Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Cardiac skeleton Child Heart Failure Body surface area Ejection fraction business.industry Infant medicine.anatomical_structure Echocardiography Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American Society of Echocardiography. 33:763-770 |
| ISSN: | 0894-7317 |
| Popis: | Background Ventricular septal defect (VSD), the most common congenital heart defect, accounts for 40% of heart malformations. Despite this prevalence, there remains no consensus on the utility of echocardiography to guide modern-era treatment. In this study, we evaluated patients with isolated VSDs to test the hypothesis that echocardiographic evidence of left ventricular (LV) volume overload and type of VSD are associated with surgical intervention and to identify useful echocardiographic indicators for management of VSDs in infants and children. Methods We reviewed 350 patients with VSDs diagnosed during the first year of life. Echocardiographic measurements were made at the time of diagnosis and at the endpoint. The VSD area was calculated using inner edge to inner edge dimensions obtained from two planes and indexed to body surface area. Aortic annulus dimension, left atrium to aortic root ratio, LV end-diastolic diameter, left atrial volume, VSD velocity-time integral, ejection fraction, and pulmonary to systemic blood flow ratio (Qp:Qs) were measured using conventional methods. Results One hundred seventy-seven muscular (50.5%) and 162 perimembranous (46%) VSDs accounted for the vast majority of defects. Only seven (4%) muscular defects required surgical closure, while 76 (47%) perimembranous defects required surgery. Indexed VSD area, VSD to aortic valve ratio, indexed left atrium volume, LV end-diastolic diameter, VSD velocity-time integral, and Qp:Qs at diagnosis were significantly different between the surgical and nonsurgical groups. Ventricular septal defect area > 50 mm2/m2 at initial diagnosis was independently associated with risk for surgery (P = .0055). Conclusions Indexed VSD area is an echocardiographic variable that can be easily measured at diagnosis and can provide insight into the likelihood of requiring surgical intervention regardless of the type and location of the defect. |
| Databáze: | OpenAIRE |
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