Natural history of isolated ventricular septal defect in the first five years of life.

BACKGROUND: Isolated ventricular septal defect (VSD) is the most common congenital heart defect. Incidence, prevalence, and clinical outcomes of VSD have been reported to vary significantly in different geographic areas. Spontaneous closure of VSD, in children, by various methods has been described.

HYPOTHESIS: This prospective study was undertaken to evaluate natural history of patients with VSD in the first five years of life in the Northeast Tennessee and Southwest Virginia region.

METHODS: Between December 1, 1998 and October 31, 1990, 124 infants were diagnosed clinically with isolated VSD. VSDs were classified as muscular, perimembranous, malalignment, or subpulmonic types by 2-dimensional echocardiogram with color flow mapping. Cardiac catheterization and angiocardiography were performed in 14 patients when clinically indicated. These patients were followed for at least five years.

RESULTS: Overall spontaneous closure of VSD was 34% at one year and 67% at five years. Twenty-five percent of perimembranous and 4% of muscular VSDs required surgery by five years. The spontaneous closure rate of muscular VSD was twice that of the perimembranous type, though the relative distribution of both types was almost equal. Overall, 22% of children with VSD need follow-up after the fifth year of life.

CONCLUSION: The overall clinical outcome of muscular VSD was consistently better than that of the perimembranous type, though 17% of muscular VSDs, irrespective of size, were open at 5 years of age and needed long-term follow-up.