Natural history of ventricular septal defects in Nigerian children
Introduction. Ventricular septal defect (VSD) is a common congenital heart disease (CHD). Spontaneous closure of the VSD may occur, depending on the type and size of defects. This study was conducted to determine the natural history of VSD in a group of Nigerian children. Subjects and methods. Sixty-one children diagnosed with VSD were prospectively studied at a tertiary centre in Nigeria until they were 2 years old. They had regular two-dimensional (2D) and Doppler echocardiography evaluations for the VSD size and closure. Results. Most (35 – 57.4%) of the patients were female, their mean age at presentation was 11.2±5.2 months, and the most common type of VSD was the perimembranous (39 – 63.9%). Almost half (28 – 45.9%) of the patients had spontaneous closure. The spontaneous closure rate was highest in muscular VSD (82.4%) and in small defects (95.0%). Incidental presence of a murmur, absence of heart failure and bronchopneumonia were good clinical predictors of closure. Only 3 (4.9%) patients had surgery abroad. There were 2 (3.3%) deaths from bronchopneumonia and bacterial endocarditis. Conclusion. Spontaneous closure readily occurs in small-sized defects and muscular VSDs. However, most patients with moderate to large VSDs are confined to long-term medical management, highlighting the need for indigenous surgical capacity in Nigeria.