Spontaneous closure of perimembranous ventricular septal defect after school age.
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 <or= Qp/Qs < 1.7; group II, 1.2 <or= Qp/Qs < 1.4; and group III, 1.0 <or= 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 >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.
Miyake
Toshiharu
T
Department of Pediatrics, Kinki University School of Medicine, Osakasayama, Osaka, Japan. miyake@kpcd.med.kindai.ac.jp
Shinohara
Tohru
T
Fukuda
Tsuyoshi
T
Ikeoka
Megumi
M
Takemura
Tsukasa
T
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000502:physiology; D012039:Regional Blood Flow; D012075:Remission, Spontaneous; D055815:Young Adult