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

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.

Abbreviations: CHB, Complete heart block, CHF, Congestive heart failure, FTT, Failure to thrive, LV, Left ventricular, LVED, Left ventricular end-diastolic dimension, NHS-II, Natural History Study of Congenital Heart Disease-II, PAH, Pulmonary hypertension, RV, Right ventricular, VSD, Ventricular septal defect