title: Second natural history study of congenital heart defects. Results of treatment of patients with ventricular septal defects.
abstract: 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.
authors.affiliation: Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
authors.forename: L
authors.initials: L
authors.lastname: Kidd
authors.forename: D J
authors.initials: DJ
authors.lastname: Driscoll
authors.forename: W M
authors.initials: WM
authors.lastname: Gersony
authors.forename: C J
authors.initials: CJ
authors.lastname: Hayes
authors.forename: J F
authors.initials: JF
authors.lastname: Keane
authors.forename: W M
authors.initials: WM
authors.lastname: O'Fallon
authors.forename: D R
authors.initials: DR
authors.lastname: Pieroni
authors.forename: R R
authors.initials: RR
authors.lastname: Wolfe
authors.forename: W H
authors.initials: WH
authors.lastname: Weidman
mesh_terms: 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