CONGENITAL ISOLATED APICAL VENTRICULAR SEPTAL-DEFECTS

The diagnosis of apical ventricular septal defects (VSDs) is difficult and the ratio of spontaneous closure is not well known. At the Ankara University Pediatric Cardiology Department, between the years 1992 an d 1997, 33 patients were identified by color-flow Doppler (CFD) imagin g as having a small defect at the apical portion of the ventricular se ptum. The age range was 1 day to 13 years. All patients were asymptoma tic with normal telecardiograms and electrocardiograms. There were gra de 2-3/6, pansystolic murmurs at the apex or closer to the apex in 19 patients. In 30 patients, narrow and short colored jets were seen at t he apex of the heart, distal to the moderator band. The jets were wide in three patients. These defects were difficult to image and required specific angulation of the transducer. Of the 23 patients who had fol low-up examinations, at 3 months to 3.5 years, there was spontaneous c losure in ten (43.5%). To the authors' knowledge, this report is the l argest series of isolated apical trabecular ventricular septal defects (t-VSDs). In their experience, color-flow imaging is more sensitive i n detecting a small apical VSD. They conclude that although the closur e of apical VSD is not the rule, the prognosis is excellent.