Evaluation of Ventricular Septal Defect Patients Attending Pediatrics Cardiac Clinic at Al-Hawari General Hospital, Benghazi-Libya

Abstract

Objective: To see the natural history and outcome of isolated ventricular septal defects in the VSD patients who follow al- Hawari pediatric cardiac clinic to evaluate the current status of the patients as well as complications of the VSD and its treatments. Settings: AL-Hawari cardiac clinic, Benghazi-Libya. University of Benghazi, Faculty of medicine. Patients and Methods: Descriptive retrospective case series study, include 140 patients with isolated VSD, period of study from   October 2010 to February 2013. Data was collected by reviewing the medical records of patients including patient’s age at last follow up time, residency, VSD Presentation, types, and size. All patients were diagnosed using transthoracic echocardiography performed by a pediatric cardiologist, VSD was classified as perimembranous, muscular, and supracrystal doubly committed further evaluation comprised a plain chest radiograph, ECG, 24-h Holter monitoring. Outcome divided into: VSD still not closed at time of the study, surgically closed, closed spontaneously, closed through Trans-catheter closure, operated with Pulmonary banding, and death. Special analysis  for the causes and the outcome  of surgical intervention ,the correlation  between VSD types, age  and outcome, as well as between size and presentation, affect of VSD on patients weight, Use of medications had been reviewed  like antibiotics given for prophylaxis against infective endocarditis, diuretics  and captopril (ACEI) for heart failure, Viagra (Sildenafil)  for pulmonary hypertension cases , as well as  digoxin . Data was analyzed manually, patients with Down syndrome and other dysmorphic syndrome were excluded from the study. Results: Total of 140 patients, 74 female and 66 male (1.1:1). The age ranged from 13days to 5years, 52 % perimembranous followed by Muscular 47%.                                                                                                                                                   38% of patients had small VSD, were 34% Moderate size. 77/140(55%) closed, with 33% Surgically closed all of them were moderate and large size , Spontaneously closed  20%, Not closed 57/140 (41%), Died 4/140 (3%), Pulmonary banding  2 /140 (1%). Spontaneous closure occurred in 20% of cases in the first year of life, and 96% below 7 year of age. Spontaneously closure cases:  82% of them were small size, and 75% were muscular. The spontaneous closure rate of muscular VSD was triple that of the Perimembranous. Most common causes of surgical intervention is heart failure 63%.  40% of surgically closed VSDs had excellent outcome, residual VSD is the most common post-operative complication with 30%. Three quarters 6/8 (75%) of patients whose their weight below 3rd centile has large VSD. Conclusion and Recommendation: Small VSDs were the comments size, and perimembranous VSDs were the comments type. Bronchopneumonia and Heart murmur were the most frequently presentation. The small and muscular ventricular septal defects had better prognosis and high tendency to close spontaneously. VSD closure surgery is safe and successful, with low mortality rate, and residual VSD is the most common post operative complication. Most of patients whose their weight below 3rd centile has large VSD. Regular updating of the data is recommended, and increase attention to save the data electronically, Establishment of more advanced and modern equipment to help in accurate diagnosis and follow up, Trying to increase and find new pediatric cardiac clinic in areas outside Benghazi in order to facilitate the process of follow-up and treatment, Education of doctors in primary health centers about the importance of  physical examination  for early detection of the disease. Increase family awareness to the disease, Future studies should include large sample size and should include other centers.