| Objective: To understand the outcome of Ventricular Septal Defect(VSD)and evaluate possible influencing factors.provide a reference for clinical follow-up and clinical intervention of infants and young children with VSD.Methods: 184 VSD cases diagnosed in Qingdao Women and Children Hospital were selected from January 2016 to December 2017.High-risk indications were evaluated with reference to the American Ultrasound Association guidelines for fetal echocardiography.VSD was diagnosed and followed up by color Doppler ultrasound.All fetuses were diagnosed by amniocentesis and non-invasive DNA detection.VSD fetuses that did not achieve natural closure after birth were followed up and echocardiograms were reviewed every 3-6 months.Data analysis was performed using SPSS 22.0 software.Results:(1)General characteristics: membrane type and funnel parts were the most common,accounting for 52.2% and 30.4% respectively.The average diameter of the defect at the time of initial diagnosis was 3.52±2.10 mm,and the most common gap was 3-4 mm,with a total of 105 cases(57.1%).(2)Evaluation results of high-risk indications: The proportion of high-risk factors and fetal high-risk factors was 29.3% and 21.2%,respectively,and the proportion of mothers combined with fetus was 12.0%.A total of 71 pregnant mothers and fetuses were identified as high risk,accounting for 38.6%.(3)Intrauterine outcome: 152 pregnant women underwent echocardiographic follow-up,8 cases(5.3%)of fetal gaps became smaller or healed naturally,and 75cases(49.3%)of defects were enlarged,69 fetuses(45.4%)were terminated pregnancy or natural death in the uterus.Fetus with small VSD defect/closed was simple VSD,and most(6 cases,75.0%)were located in the muscle,mainly small defects(7 cases,87.5%).(4)Postpartum follow-up of VSD: 110 cases of live birth and follow-up of children with VSD after birth.Echocardiographic follow-up results showed that the natural healing rate of defects was 31.8% within 1 year,the defect was reduced but the rate of non-healing was 20.0%,and the proportion of defect increase was 48.2%.There were no statistical differences in the characteristics of patients with different genders,whether there were malformations,and whether there were high risk factors(P>0.05).There were significant difference in the gap between the different VSD clinical classifications and the diameter of the gap at the time of initial diagnosis(P<0.05).The proportion of natural healing in the perimembranous,funnel,and muscle VSD was 24.5%,15.4%,and 60.0%,respectively.The natural healing rate of VSD in the muscle site was significantly higher than other types(P<0.05).The prenatal diagnosis of the defect diameter <3mm has a higher natural healing rate after birth,reaching 88.9%;the natural healing rate after birth of 3-4mm and ≥5mm is16.9% and 0.0%,respectively,which is significantly lower than the defect diameter<3mm(P < 0.05).The natural healing rate of isolated VSD and other cardiac malformations after VSD was 34.4% and 10.5%,the difference was significant(P<0.05).The natural healing rate of high-risk and non-high-risk patients was 14.3%and 37.8%,respectively,and the natural healing rate of high-risk patients was significantly lower within 1 year(P<0.05).The log-mean left-right shunt velocity was0.16±0.11 and 0.12±0.10,respectively,and the log-mean of right-left shunt velocity was 0.13±0.09 and 0.21±0.13,respectively.The logarithm of right-left shunt velocity was significantly lower in children with natural healing within 1 year of birth,and the difference was statistically significant(P<0.05).There was no significant difference in gestational age,birth weight,and neonatal asphyxia between the natural and unnaturally healed children within 1 year of birth(P>0.05).1min Apgar score at birth was significantly lower in children with natural healing than those without natural healing.There was no statistical difference in the distribution of maternal age,education level,family monthly income,parity and breastfeeding time between natural healing and unnatural healing within 1 year(P>0.05).(5)The results of conditional logistic regression analysis showed that the clinical classification of VSD,the size of the defect at the time of initial diagnosis,combined cardiac malformations,risk factors for pregnancy,and whether the logarithm of right-left shunt velocity was within 1 year after birth in children with VSD Independent influencing factors of natural healing.muscular ventricular septal defect,small defect at the time of initial diagnosis,isolated VSD,prenatal risk factors were judged as non-high risk,and the right-to-left shunt speed was lower were protective factors.Conclusion:(1)Echocardiography has high efficiency in the diagnosis and follow-up of VSD,and can be used as the basic method for VSD diagnosis and follow-up.(2)VSD has a low natural closure rate in the uterus and a high natural closure rate at 1year after birth.(3)VSD infant natural closure is affected by defect type,defect size,defect blood flow characteristics,prenatal high risk factors and combined malformation.Clinically,the intrauterine intervention and post-partum treatment plan and strategy can be formulated according to the above characteristics. |
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