Abstract 20196: Ventricular Septal Defect Presentation and Outcomes - An Echocardiography Based Retrospective Review
Introduction: Ventricular septal defect (VSD) accounts for up to 40% of cardiac malformations. A significant left to right shunt can cause left atrial and ventricular overload, pulmonary arterial hypertension, ventricular dysfunction and aortic regurgitation. Surgical intervention has excellent outcomes, with little risk. Prior studies have quantified VSD size as it relates to natural history, but there is scarce literature examining the correlation between echocardiographic variables and VSD outcomes in large cohorts in the current era.
Hypothesis: This study aimed to characterize the correlation between echocardiographic variables and VSD outcomes. We endeavor to add to literature used to weigh the risk of surgery against the natural history of an untreated VSD.
Methods: Retrospective chart and echocardiographic review of VSDs diagnosed at Lucile Packard Children’s Hospital at Stanford from January 2001 through December 2008.
Results: Of 215 VSDs, 101 (47%) were perimembranous, 95 (44%) were muscular, 2 (1%) were malalignment, 8 (4%) were supracristal and 9 (4%) were swiss cheese VSDs. Surgery was performed in 100% of supracristal and malalignment, 46% of perimembranous, 4% of muscular and 0% of swiss cheese VSDs. Logistic regression showed VSD area (measured in 2 orthogonal axes)/BSA was an independent predictor for surgery (p = 0.0032). Table 1 demonstrates echocardiographic variables significantly associated with surgery. In regards to natural history, for VSDs not requiring surgery, 18% of perimembranous, 58% of muscular and 43% of swiss cheese VSDs closed spontaneously over 32 to 2721 (median 409, mean 632) days following diagnosis.
Conclusions: The majority of VSD cases were perimembranous and muscular. Nearly half of perimembranous VSDs required surgery. VSD dimension/aortic valve size, interventricular flow velocity and VSD VTI, at time of diagnosis, were correlated with need for surgery. VSD area/BSA was an independent predictor for surgery.
Author Disclosures: K. Cox: None. R. Punn: None. N. Silverman: None.
- © 2016 by American Heart Association, Inc.