Ventricular septal defect: Clinical and hemodynamic changes in the first five years of life

Abstract Two hundred consecutive infants with isolated ventricular septal defects were assessed clinically and hemodynamically and then followed throughout the first 5 years of life. Those infants who had flow ratios less than 2 to 1 generally became asymptomatic because of diminution in size of the defect. Complete closure occurred spontaneously in 20 per cent. The majority of infants had flow ratios greater than 2:1 and in these the natural evolution varied. At least 15 per cent of these infants may die from their cardiac lesion in infancy. However, approximately 40 per cent of those who survive will have closed defects, and 20 per cent of those who show this reduction in size will have spontaneously closed defects by 5 years of age. Those children in whom the large defect persists remain symptomatic and fail to thrive. There is little or no change in clinical, radiologic, or electrocardiographic findings up to the time of surgery, but hemodynamic reassessment indicates that at least 20 per cent of such children may develop progressive pulmonary arteriolar disease and that such changes, when they are going to occur, will be evident hemodynamically in the second year of life. When all the children with flow ratios greater than 2 to 1 are considered, the mortality rate was 7 per cent; 9 per cent required palliative surgery in infancy; 6 per cent underwent spontaneous closure; and 10 per cent developed the Eisenmenger reaction.