SPONTANEOUS FUNCTIONAL CLOSURE OF VENTRICULAR SEPTAL DEFECTS IN FOURTEEN CHILDREN DEMONSTRATED BY SERIAL CARDIAC CATHETERIZATIONS AND ANGIOCARDIOGRAPHY

Abstract

Spontaneous functional closure of ventricular septal defect, demonstrated by serial hemodynamic and angiocardiographic studies, in 14 patients, is reported. The typical holosystolic murmur disappeared in seven patients, and was replaced by an insignificant basal, ejection, systolic murmur in five of them. In the other seven patients the holosystolic murmur persisted, but decreased in intensity. On initial cardiac catheterization a left-to-right shunt at ventricular level was demonstrated in all 14 patients from oxygen saturation data and by angiocardiography. On subsequent cardiac catheterizations performed 13 months to 6 years later, no shunt was shown by oxygen saturation data and only by selective dye dilution studies and left ventricular angiocardiography was a small shunt demonstrable in six cases. Our findings substantiate the views and experiences of others that in some ventricular septal defects, which may occasionally be so large as to result in heart failure in infancy, spontaneous closure does occur. The possible mechanism for this closure is discussed. With this information added to our total experience with ventricular septal defects, we favor a conservative attitude in recommending surgical intervention in infants with this entity.