Treatment of ventricular septal defect in children: Who, when, and how? A 20-years Lebanese multicentric retrospective study

Introduction: Ventricular Septal Defect (VSD) is a common congenital heart disease. Three therapeutic approaches exist to treat this anomaly: observation and regular follow-up, surgical closure, and Tran’s catheter intervention. We seek through this study to determine the appropriate indications for surgical and non­surgical treatment of VSD. Methods: We conducted a retrospective multicentric study between January 1, 2000 and June 30, 2020 on 942 VSD carriers. Cases with isolated VSD were studied for age of presentation, sex, type of VSD, and VSD outcome. Results: Majority of our patients (60.5%) had a perimembranous VSD. During 20 years of follow-up, 220 underwent an intervention for their cardiac anomaly (either surgery or catheterization) and 722 received medical treatment and were under observation. Among patients who were solely monitored, 36.7% patients had a complete spontaneous closure of their VSD, 20.9% had a partial closure, and 39.9% had an unchanged VSD size. Patients with perimembranous and inlet types were significantly more likely to undergo an intervention (p=0.018). The most common reason behind intervention was severe pulmonary arterial hypertension seen in 140 cases. Furthermore, 18 cases out of 457 unclosed VSD developed complications during follow-up. Conclusion: We found that 36.7% of VSDs might totally close over time, particularly if VSD is of muscular type. This rate might also increase with a longer follow-up period.