MORPHOLOGICAL, HEMODYNAMIC, AND CLINICAL-VARIABLES AS PREDICTORS FOR MANAGEMENT OF ISOLATED VENTRICULAR SEPTAL-DEFECT

Objective-To assess the predictive impact of morphological, haemodynam ic, and clinical variables in the management of patients with isolated ventricular septal defect. Design-Retrospective analysis of variables by a sophisticated database management system. Patients and methods-2 63 consecutive patients with isolated ventricular septal defect diagno sed by echocardiography. The morphological type and haemodynamic chara cter of the ventricular septal defect was characterised in each patien t. In addition, variables were introduced to represent the need for di uretics, growth, and potential delay in growth. In 43 patients (16.3%) the ventricular septal defect was closed surgically; 220 patients (83 .7%) were managed conservatively and spontaneous closure of the ventri cular septal defect occurred in 65 (29.5%). There were no deaths. Resu lts-All patients managed surgically had non-restrictive defects and we re operated on during the first year of life. A few patients with non- restrictive defects were managed conservatively. The two groups differ ed significantly only with respect to mean growth delay (0.65 (0.27) v 0.9 (0.21), P < 0.001). Only the morphology of the ventricular septal defect significantly (P < 0.001) influenced the probability of closur e. Conclusions-Findings imply that early surgical closure of ventricul ar septal defect is indicated in patients with nonrestrictive ventricu lar septal defect and severe growth delay. Other patients should be ma naged conservatively. In these patients the morphological type of the defect determines the probability of spontaneous closure and provides an estimate of the period over which decrease in size or closure can b e expected.