Spontaneous Regression of Left Ventricular Dilation in Children with Restrictive Ventricular Septal Defects

Charles S. Kleinman, Mahnaz Tabibian, Thomas J. Starc, Daphne T. Hsu, Welton M. Gersony

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objectives: To test the hypothesis that left ventricular (LV) dilation associated with pressure-restrictive ventricular septal defect (VSD) often remains stable or regresses spontaneously, calling into question the role of interventional management for such defects. Study design: We analyzed 96 serial echocardiograms from 33 unoperated patients with a moderate-to-large VSD with LV dilation (LV end-diastolic dimension [LVED] z score >2.0) at enrollment who were followed for more than 2 years. Records of 125 surgical patients also were reviewed. Patients were evaluated for evidence of persistent or progressive LV dilation; signs or symptoms of congestive heart failure (CHF), failure to thrive (FTT), or pulmonary hypertension (PAH); as well as acquired ventricular outflow obstruction or aortic regurgitation. LVED z scores at enrollment versus latest follow-up were compared using paired t tests. A random-effects model with random intercept and slope was fitted to account for repeated observations for each patient. Results: Mean age at enrollment was 4.6 ± 3.2 years, and mean follow-up was 7.8 ± 4 years (range, 2.8 to 22 years), during which mean LVED z score decreased from 3.0 ± 0.6 to 1.2 ± 1.3 (P < .01). LVED z score decreased in 29 of the 33 patients, and decreased to <2 in 26 of these 29 (79%). Conclusions: Most patients with pressure-restrictive VSD with moderate-to-severe LV dilation without CHF, FTT, or PAH will experience spontaneous resolution of LV dilation and can avoid cardiac surgery or catheter-based intervention.

Original languageEnglish (US)
Pages (from-to)583-586
Number of pages4
JournalJournal of Pediatrics
Volume150
Issue number6
DOIs
StatePublished - Jun 2007
Externally publishedYes

Fingerprint

Ventricular Heart Septal Defects
Dilatation
Failure to Thrive
Pulmonary Hypertension
Heart Failure
Cardiac Catheters
Ventricular Outflow Obstruction
Pressure
Aortic Valve Insufficiency
Thoracic Surgery
Signs and Symptoms

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Spontaneous Regression of Left Ventricular Dilation in Children with Restrictive Ventricular Septal Defects. / Kleinman, Charles S.; Tabibian, Mahnaz; Starc, Thomas J.; Hsu, Daphne T.; Gersony, Welton M.

In: Journal of Pediatrics, Vol. 150, No. 6, 06.2007, p. 583-586.

Research output: Contribution to journalArticle

Kleinman, Charles S. ; Tabibian, Mahnaz ; Starc, Thomas J. ; Hsu, Daphne T. ; Gersony, Welton M. / Spontaneous Regression of Left Ventricular Dilation in Children with Restrictive Ventricular Septal Defects. In: Journal of Pediatrics. 2007 ; Vol. 150, No. 6. pp. 583-586.
@article{daeb3a51f91043f6bb4b70fa3e191a94,
title = "Spontaneous Regression of Left Ventricular Dilation in Children with Restrictive Ventricular Septal Defects",
abstract = "Objectives: To test the hypothesis that left ventricular (LV) dilation associated with pressure-restrictive ventricular septal defect (VSD) often remains stable or regresses spontaneously, calling into question the role of interventional management for such defects. Study design: We analyzed 96 serial echocardiograms from 33 unoperated patients with a moderate-to-large VSD with LV dilation (LV end-diastolic dimension [LVED] z score >2.0) at enrollment who were followed for more than 2 years. Records of 125 surgical patients also were reviewed. Patients were evaluated for evidence of persistent or progressive LV dilation; signs or symptoms of congestive heart failure (CHF), failure to thrive (FTT), or pulmonary hypertension (PAH); as well as acquired ventricular outflow obstruction or aortic regurgitation. LVED z scores at enrollment versus latest follow-up were compared using paired t tests. A random-effects model with random intercept and slope was fitted to account for repeated observations for each patient. Results: Mean age at enrollment was 4.6 ± 3.2 years, and mean follow-up was 7.8 ± 4 years (range, 2.8 to 22 years), during which mean LVED z score decreased from 3.0 ± 0.6 to 1.2 ± 1.3 (P < .01). LVED z score decreased in 29 of the 33 patients, and decreased to <2 in 26 of these 29 (79{\%}). Conclusions: Most patients with pressure-restrictive VSD with moderate-to-severe LV dilation without CHF, FTT, or PAH will experience spontaneous resolution of LV dilation and can avoid cardiac surgery or catheter-based intervention.",
author = "Kleinman, {Charles S.} and Mahnaz Tabibian and Starc, {Thomas J.} and Hsu, {Daphne T.} and Gersony, {Welton M.}",
year = "2007",
month = "6",
doi = "10.1016/j.jpeds.2007.02.065",
language = "English (US)",
volume = "150",
pages = "583--586",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Spontaneous Regression of Left Ventricular Dilation in Children with Restrictive Ventricular Septal Defects

AU - Kleinman, Charles S.

AU - Tabibian, Mahnaz

AU - Starc, Thomas J.

AU - Hsu, Daphne T.

AU - Gersony, Welton M.

PY - 2007/6

Y1 - 2007/6

N2 - Objectives: To test the hypothesis that left ventricular (LV) dilation associated with pressure-restrictive ventricular septal defect (VSD) often remains stable or regresses spontaneously, calling into question the role of interventional management for such defects. Study design: We analyzed 96 serial echocardiograms from 33 unoperated patients with a moderate-to-large VSD with LV dilation (LV end-diastolic dimension [LVED] z score >2.0) at enrollment who were followed for more than 2 years. Records of 125 surgical patients also were reviewed. Patients were evaluated for evidence of persistent or progressive LV dilation; signs or symptoms of congestive heart failure (CHF), failure to thrive (FTT), or pulmonary hypertension (PAH); as well as acquired ventricular outflow obstruction or aortic regurgitation. LVED z scores at enrollment versus latest follow-up were compared using paired t tests. A random-effects model with random intercept and slope was fitted to account for repeated observations for each patient. Results: Mean age at enrollment was 4.6 ± 3.2 years, and mean follow-up was 7.8 ± 4 years (range, 2.8 to 22 years), during which mean LVED z score decreased from 3.0 ± 0.6 to 1.2 ± 1.3 (P < .01). LVED z score decreased in 29 of the 33 patients, and decreased to <2 in 26 of these 29 (79%). Conclusions: Most patients with pressure-restrictive VSD with moderate-to-severe LV dilation without CHF, FTT, or PAH will experience spontaneous resolution of LV dilation and can avoid cardiac surgery or catheter-based intervention.

AB - Objectives: To test the hypothesis that left ventricular (LV) dilation associated with pressure-restrictive ventricular septal defect (VSD) often remains stable or regresses spontaneously, calling into question the role of interventional management for such defects. Study design: We analyzed 96 serial echocardiograms from 33 unoperated patients with a moderate-to-large VSD with LV dilation (LV end-diastolic dimension [LVED] z score >2.0) at enrollment who were followed for more than 2 years. Records of 125 surgical patients also were reviewed. Patients were evaluated for evidence of persistent or progressive LV dilation; signs or symptoms of congestive heart failure (CHF), failure to thrive (FTT), or pulmonary hypertension (PAH); as well as acquired ventricular outflow obstruction or aortic regurgitation. LVED z scores at enrollment versus latest follow-up were compared using paired t tests. A random-effects model with random intercept and slope was fitted to account for repeated observations for each patient. Results: Mean age at enrollment was 4.6 ± 3.2 years, and mean follow-up was 7.8 ± 4 years (range, 2.8 to 22 years), during which mean LVED z score decreased from 3.0 ± 0.6 to 1.2 ± 1.3 (P < .01). LVED z score decreased in 29 of the 33 patients, and decreased to <2 in 26 of these 29 (79%). Conclusions: Most patients with pressure-restrictive VSD with moderate-to-severe LV dilation without CHF, FTT, or PAH will experience spontaneous resolution of LV dilation and can avoid cardiac surgery or catheter-based intervention.

UR - http://www.scopus.com/inward/record.url?scp=34248537742&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34248537742&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2007.02.065

DO - 10.1016/j.jpeds.2007.02.065

M3 - Article

VL - 150

SP - 583

EP - 586

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

IS - 6

ER -