Background

Ventricular septal defect (VSD), the most common congenital heart defect, accounts for 40% of heart malformations. Despite this prevalence, there remains no consensus on the utility of echocardiography to guide modern-era treatment. In this study, we evaluated patients with isolated VSDs to test the hypothesis that echocardiographic evidence of left ventricular (LV) volume overload and type of VSD are associated with surgical intervention and to identify useful echocardiographic indicators for management of VSDs in infants and children.

Methods

We reviewed 350 patients with VSDs diagnosed during the first year of life. Echocardiographic measurements were made at the time of diagnosis and at the endpoint. The VSD area was calculated using inner edge to inner edge dimensions obtained from two planes and indexed to body surface area. Aortic annulus dimension, left atrium to aortic root ratio, LV end-diastolic diameter, left atrial volume, VSD velocity-time integral, ejection fraction, and pulmonary to systemic blood flow ratio (Qp:Qs) were measured using conventional methods.

Results

One hundred seventy-seven muscular (50.5%) and 162 perimembranous (46%) VSDs accounted for the vast majority of defects. Only seven (4%) muscular defects required surgical closure, while 76 (47%) perimembranous defects required surgery. Indexed VSD area, VSD to aortic valve ratio, indexed left atrium volume, LV end-diastolic diameter, VSD velocity-time integral, and Qp:Qs at diagnosis were significantly different between the surgical and nonsurgical groups. Ventricular septal defect area > 50 mm²/m² at initial diagnosis was independently associated with risk for surgery (P = .0055).

Conclusions

Indexed VSD area is an echocardiographic variable that can be easily measured at diagnosis and can provide insight into the likelihood of requiring surgical intervention regardless of the type and location of the defect.

中文翻译：

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婴儿期室间隔缺损的自然和非自然病史：基于超声心动图的综述。

背景

室间隔缺损（VSD）是最常见的先天性心脏缺陷，占心脏畸形的 40%。尽管如此普遍，但对于超声心动图指导现代治疗的效用仍未达成共识。在本研究中，我们评估了孤立性 VSD 患者，以检验左心室 (LV) 容量超负荷的超声心动图证据和 VSD 类型与手术干预相关的假设，并确定有用的超声心动图指标来管理婴儿和儿童的 VSD。

方法

我们回顾了 350 名在出生后第一年诊断出的 VSD 患者。在诊断时和终点时进行超声心动图测量。VSD 面积是使用从两个平面获得的内边缘到内边缘尺寸计算的，并以体表面积为索引。使用常规方法测量主动脉瓣环尺寸、左心房与主动脉根比、左心室舒张末期直径、左心房容积、VSD 速度-时间积分、射血分数和肺与全身血流量比 (Qp:Qs)。

结果

177 个肌肉 (50.5%) 和 162 个膜周 (46%) VSD 占绝大多数缺陷。只有 7 个 (4%) 肌肉缺损需要手术闭合，而 76 个 (47%) 膜周缺损需要手术。手术组和非手术组之间的索引 VSD 面积、VSD 与主动脉瓣比率、索引左心房容积、LV 舒张末期直径、VSD 速度-时间积分和诊断时的 Qp:Qs 显着不同。初始诊断时室间隔缺损面积 > 50 mm ² /m ²与手术风险独立相关 ( P  = .0055)。

结论

索引 VSD 区域是一个超声心动图变量，可以在诊断时轻松测量，并且可以深入了解需要手术干预的可能性，而不管缺陷的类型和位置。