We sudied, with echocardiography as a main tool, the natural processes of 211 patients with uncomplicated ventricular septal defect (VSD) (incidence, 5.33 per 1,000 live births); 146 (69.2%) had a perimenbranous VSD and 32 (15.2%) had a subarterial, 25 (11.8%) had a muscular type of VSD. Cumulative rate of spontaneous closure was 26.1%. In the closure processes, about three-fourth of perimembranous VSD showed a partial closure or tunnel formation by changes of septal leaflet of the tricuspid valve, remaining one-fourth showed a "functional" complete closure. Four of 58 neonates had a partially closed-perimembranous VSD. Rates of infundibular stenosis and Eisenmenger syndrome were 6.6% and 1.4% respectively. Aortic prolapse with insufficiency was detected in 6 patients who were over 6 years of age. Surgical closure was required in 27.5% of all studied patients and in 12% of infants (14 of 177). No natural deaths were observed during the study-periods of recent 3 years. But, 3 of 58 (5.2%) were dead postoperativel (two were early, one late). Doppler color flow mapping is a valuble aid in the diagnosis of VSD and may be on reason for the observed increase in the incidence of VSDs.
Constriction, Pathologic ; Diagnosis ; Echocardiography* ; Eisenmenger Complex ; Heart Septal Defects, Ventricular* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Prolapse ; Tricuspid Valve

A 34-year-old woman was admitted to the hospital because of recently aggravated right heart failure without angina for 5 months. When she was 25 years old, patch repair with Polytetrafluoroethylene (PTFE) was performed for the secondum type of atrial septal defect (ASD) with moderate pulmonary hypertension. The chest PA, echocardiography and cardiac catheterization at current admission revealed Eisenmenger syndrome without intracardiac shunt. Chest CT scan with contrast revealed markedly dilated pulmonary trunk, both pulmonary arteries and concave disfigurement of the left side of the ascending aorta suggesting extrinsic compression, as well as total occlusion of the ostium of the left main coronary artery that was retrogradly filled with collateral circulation from the right coronary artery. The coronary angiography showed normal right coronary artery and the collaterals that come out from the conus branch to the mid-left anterior descending artery (LAD) and that from distal right coronary artery to the left circumflex artery (LCX) and to the distal LAD, respectively. On aortography, the left main coronary artery was not visualized with no stump, suggestive of total occlusion of the ostium of the left main coronary artery. From our experience, it is possible to say that the occlusion of the ostium of the left main coronary can be induced by the dilated pulmonary artery trunk due to ASD with pulmonary hypertension and that, if the ASD closure was too late, the narrowing or obstruction of the left coronary artery could not be resolved even after operation owing to irreversible pulmonary hypertension.
Adult ; Case Report ; Constriction, Pathologic/etiology/radiography ; Coronary Disease/*etiology/radiography ; Dilatation, Pathologic/etiology ; Eisenmenger Complex/diagnosis ; Female ; Heart Septal Defects, Atrial/*complications ; Human ; Hypertension, Pulmonary/*complications ; *Pulmonary Artery/radiography