title: Prediction of spontaneous closure of isolated ventricular septal defects in utero and postnatal life.
abstract: Ventricular septal defect (VSD) is a highly prevalent fetal congenital heart defect, which can become spontaneously closed during infancy. The current study aims to characterize fetal VSDs that were subsequently spontaneously closed in the first 2 years of life in eastern China.
  
  
  
  Between January 2011 and December 2013, 257 fetal patients diagnosed with isolated VSD by fetal echocardiography at Nanjing Maternity and Child Health Care Hospital, China, were enrolled in the study. Subjects were divided into three groups: group 1 = persistent VSD; group 2 = closed after birth; group 3 = closed during gestation. Fetal echocardiography data, physical features at birth and follow-up outcomes for 2 years were compared to identify factors contributing to spontaneous closure (SC) of VSD. A predictive formula was applied to patients admitted to hospital in the first quarter of 2014 (n = 23) for validation.
  
  
  
  SC occurred in 42.8% patients. Birth weight (3.095 ± 0.774, 3.174 ± 0.535, 3.499 ± 0.532 kg in groups 1, 2 and 3, respectively) and defect diameter (3.422 ± 0.972, 2.426 ± 0.599, 2.292 ± 0.479 mm, in groups 1, 2 and 3, respectively) showed statistically significant differences between the three groups (P = 0.004 and P = 0.000, respectively). Receiver operating characteristic (ROC) curves identified cut-off value for the defect diameter as 2.55 mm, and logistic regression analysis identified the SC probability = (1 + exp -[-2.151 - 0.716*birth weight + 1.393*diameter])-1. Results indicated that male fetuses, full-term birth, muscular VSD, and defects without blood flow crossing the septum, have higher incidence of SC.
  
  
  
  The major determinants of SC of isolated VSD are birth weight and diameter of the defect. In addition, VSD location may also affect the SC incidence.
authors.affiliation: Department of Cardiology, Wuxi Second Hospital, Nanjing Medical University, No.68 Zhongshan Road, Wuxi, Jiangsu Province, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Cardiology, Jiangsu Taizhou People's Hospital, Taizhou, Jiangsu Province, China.
authors.forename: Gui-Xian
authors.initials: GX
authors.lastname: Song
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
authors.forename: Li-Jie
authors.initials: LJ
authors.lastname: Wu
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Chen
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Fetal Echocardiography, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No.123 Tianfei Lane, Mochou Road, Nanjing, Jiangsu Province, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Cardiology, Jiangsu Taizhou People's Hospital, Taizhou, Jiangsu Province, China.
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Shen
authors.affiliation: Department of Fetal Echocardiography, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, No.123 Tianfei Lane, Mochou Road, Nanjing, Jiangsu Province, China. njcaoli7@hotmail.com.
authors.forename: Li
authors.initials: L
authors.lastname: Cao
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China. lmqian@njmu.edu.cn.
authors.forename: Ling-Mei
authors.initials: LM
authors.lastname: Qian
mesh_terms: D002675:Child, Preschool; D003661:Decision Support Techniques; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D012372:ROC Curve; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal
keywords: Fetal echocardiography; Spontaneous closure; Ventricular septal defects