ECHOCARDIOGRAPHIC FOLLOW-UP POST VENTRICULAR SEPTAL DEFECT CLOSURE

Abd Almohsen A. M., Allam A. R., Eldomiati A. M.*, Sabah M. H. and Antonios A. M.

ABSTRACT

Background: The most common form of congenital heart disease in childhood is the ventricular septal defect (VSD), occurring in 50% of all children with congenital heart disease and in 20% as an isolated lesion. The size of the VSD, the pressure in the right and left ventricular chambers, and the pulmonary resistance are factors that influence the hemodynamic significance of VSDs. Left-to-right shunting in VSDs generally increases pulmonary arterial blood flow and pulmonary venous return to the left heart. These pathophysiologic sequels may result in volume overload of the left atrium and left ventricle, and subsequent left ventricular enlargement, mitral annular dilation, mitral regurgitation, and consequent left atrial enlargement to allow for the homeostatic balance of left atrial pressure. Aim: The aim of the work is to assess the extent of improvement of LV dimensions after surgical closure of VSD. Methods: This prospective non controlled study was conducted on 30 children with isolated congenital ventricular septal defect after the surgical closure of VSD. All patients were brought for follow up visits where transthoracic echocardiography repeated immediately after surgery and at 3 and 6 months postoperative for assessment of adequacy of VSD closure, improvement of left sided dimensions and residual mitral regurge. Results: The current study showed that mean age of studied patients was 22.9 +/-29 months. About 17 were females, and 13 were males. Sixty eight percent had perimembranous VSD, 13% had muscular VSD, 10% had inlet VSD and 10% had outlet VSD. Eighty percent of our patients had no MR, 13% had mild MR, 7% had moderate MR. There was significant increase in ejection fraction in postoperative follow-up echocardiography. There was significant progressive reduction in left ventricular end diastolic diameter and end systolic diameter in 3 and 6 months follow up echo studies. Degree of mitral regurgitation did not significantly decreased post- surgery. Conclusion: Surgical closure of VSD in infancy results in improvement of left ventricular ejection fraction and reduction of left ventricular dimensions.

Keywords: Ventricular septal defect, echocardiography, diagnosis, surgical closure.