Small Ventricular Septal Defect Considered not Requiring Surgical Closure: The Frequency of Developing Complications in Our Center.
Isolated ventricular septal defect occurs in approximately 2-6 of every 1000 live births and
accounts for more than 15-20% of all congenital heart diseases. Soto et al divided VSD into
Perimembranous, Muscular and Doubly committed sub-arterial (DCSA) types. It had been
well accepted for many years that patients with a small ventricular septal defect (VSD) as defined by a left-to-right shunt of <50%, normal pulmonary artery pressure (PAP), and absence of symptoms do not require surgical repair.3,4 Operation were postponed on the observation that
VSDs frequently close spontaneously.
This complication is observed only in 5% of patients with ventricular septal defect. Aortic regurgitation occurs due to a poorly supported right coronary cusp combined with the Venturi effect produced by the ventricular septal defect jet, resulting in cusp prolapsed. Aortic regurgitation is progressive in nature and presence of even mild aortic regurgitation or aortic valve prolapse in the absence of aortic regurgitation is an indication for surgery.
The natural history has a wide spectrum, ranging from spontaneous closure to congestive heart failure (CHF) to death in early infancy. Spontaneous closure frequently occurs in children, usually by age of 2 years. Outlet ventricular septal defects have a low incidence of spontaneous closure, and inlet ventricular septal defects does not close.
The significant number of patients of restrictive small ventricular septal defect developed complications in our study. Another follow-up study revealed that 22% subjects had major, VSD-related complications.
Patients with obvious prolapse of an aortic cusp into the VSD have the highest risk of developing progressive aortic regurgitation. We found 2.3% of our patients developed aortic regurgitation which was more common in case of perimembranous type of VSD.
Heart Res Open J. 2016; 2(5): 144-149. doi: 10.17140/HROJ-2-126