Second natural history study of congenital heart defects. Results of treatment of patients with ventricular septal defects.
BACKGROUND
From 1958 to 1969, 1,280 patients (mostly children) with ventricular septal defects (VSDs) were admitted to the First Natural History Study of Congenital Heart Defects (NHS-1) after cardiac catheterization. Most with small defects and Eisenmenger's syndrome were managed medically; most with large VSDs were managed surgically. Of those with moderate-size defects, some were managed medically, and some were managed surgically. Most had a second catheterization at the conclusion of NHS-1. More than 15 years have elapsed since NHS-1, and most of the cohort are adults. This report (Second Natural History Study) addresses the long-term results of medical and surgical management.


RESULTS
Of an original cohort of 1,280 patients, 1,099 were alive at completion of NHS-1. New data were obtained on 976 (76.3%) of the original cohort. Probability of 25-year survival was 87%, and admission severity was the best predictor of survival. Of the 860 patients managed medically during NHS-1, 245 subsequently required surgical closure of the VSD. Only 5.5% of patients who had surgical closure required a second operation. On follow-up, there was a higher-than-normal prevalence of serious arrhythmias. Bacterial endocarditis occurred rarely. Of patients with small VSDs, 94.1% were in New York Heart Association functional class I. With the exception of those with Eisenmenger's syndrome, most patients had a final clinical status that was excellent or good.


CONCLUSIONS
The majority of patients fared well. However, there was a higher-than-normal prevalence of serious arrhythmia and sudden death, including those with small VSDs.
Kidd
L
L
Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Driscoll
D J
DJ
Gersony
W M
WM
Hayes
C J
CJ
Keane
J F
JF
O'Fallon
W M
WM
Pieroni
D R
DR
Wolfe
R R
RR
Weidman
W H
WH
D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology; D007223:Infant; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D016019:Survival Analysis