Small ventricular septal defect: long-term expectant clinical management.
BACKGROUND
The small ventricular septal defect (VSD) usually presents good clinical evolution, even at long-term follow-up.


OBJECTIVE
To verify the clinical evolution of patients with small VSD in order to determine the continuation or not of the expectant conduct, considering the low operative risk, which results in a more liberal indication for surgery.


METHODS
From October 1976 to December 2007, 187 cases of small VSD (diameter < 3 mm at the echocardiogram) were evaluated and 155 of them were assessed at long-term follow-up. Time of the clinical manifestation of the murmur and evolution aspects such as the spontaneous closure of the defect (group I)--64 cases, persistence of the initial size (group II--74 cases and decrease in the size of the defect (group III)--17 cases, in addition to clinical complications, were studied.


RESULTS
The clinical manifestation of the murmur occurred, in the majority of cases, during the first month of life, corresponding to 48 (75%), 54 (72.9%) and 12 (70.5%) patients, in the three groups, respectively and after the first year of life in 11 (5.8%) patients. Spontaneous closure occurred in the first year of life in 48 cases (75%), mean of 7.6 months and from 1 to 5.5 years in 15 patients (23.4%), with a maximum follow-up of 18 years. The persistence of the defect until 40 years of age was observed. The decrease in the size of the defect occurred on a mean of 15 months, followed for up to 9 years. The probability of VSD closure by the actuarial curve was 34.38% in 1 year and 49.89% in 5 years. There were no clinical complications.


CONCLUSIONS
A favorable evolution of the small VSD at long-term follow-up does not require surgical intervention, with concerns regarding the strict antibiotic prophylaxis.
Atik
Edmar
E
conatik@incor.usp.br
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006337:Heart Murmurs / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult