VENTRİKÜLER SEPTAL DEFEKT TANISI, BOYUT VE TİPLERİ, KOMPLİKASYONLARI VE SPONTAN KAPANMA ORANLARI COVİD-19 PANDEMİSİNDEN ETKİLENDİ Mİ?

Abstract

Amaç Polikliniğimize yönlendirilen hastalardan ventriküler septal defekt tespit edilenlerin sayısı, ventriküler septal defekt yeri ve boyutu, yol açtığı komplikasyonlar, medikal, cerrahi ya da spontan kapanma olasılığı incelenmiş, Covid-19 pandemisi koşullarında, rutin poliklinik muayene sayılarında ve VSD tanısı koyma oranında bir farklılık olup olmadığı, pandemi öncesi verilerimiz ile kıyaslanmıştır. Gereç ve Yöntem 2018-2022 yılları arasında hekime, göğüs ağrısı, çarpıntı, çabuk yorulma, nefes almada zorlanma, bayılma gibi semptomlar veya kalp dışı herhangi bir şikayet ile başvuru sırasında rutin muayenede üfürüm duyulması nedeniyle yapılan transtorasik ekokardiyografi sonuçları değerlendirilmiştir. Bulgular Pandemi öncesi 2018-2020 yılları arasındaki ekokardiyografi yapılan 16362 hastanın 91’inde (grup 1), pandemi dönemi olan 2020-2022 yılları arasında ekokardiyografi yapılan 14248 hastanın 202’sinde (grup 2), ventriküler septal defekt görülmüş olup, pandemi döneminde ventriküler septal defektli hasta oranının daha fazla olması yönünde anlamlıdır (p <0.001). Ventriküler septal defektlerin izleminde çeşitli komplikasyonlar gelişebilmektedir. Total olarak tüm komplikasyonlara sayı olarak bakıldığında pandemi öncesi dönemde komplikasyon oranı istatistiksel olarak anlamlı derecede daha fazladır (p=0.003). Ancak gelişen komplikasyonlar ayrı ayrı değerlendirildiğinde sadece ventriküler septal anevrizma gelişimi açısından pandemi öncesi grupta (grup 1) daha fazla oranda olması yönünde anlamlı fark saptandı (p=0.002). Diğer komplikasyonlar açısından anlamlı fark saptanmamıştır. Sonuç Hasta sayılarının benzer olması bize pediatrik kardiyoloji poliklinik başvuru sayılarında, pandemi koşullarında dahi ciddi bir azalma olmadığını kanıtlamıştır. Ancak ventriküler septal defekt tanı alma sıklığının pandemi döneminde daha fazla oranda olması, bu dönemde hastaneye gerçekten pediatrik kardiyoloji muayenesi gerektiren hastaların başvurmasından kaynaklanabilir.

Keywords

• COVID-19 pandemisi ve VSD
• Komplikasyonlar
• Spontan kapanma
• Ventriküler septal defekt (VSD)

ARE VENTRICULAR SEPTAL DEFECT DIAGNOSES IN PEDIATRIC AGE GROUP AFFECTED BY THE COVID-19 PANDEMIC?

Abstract

Objective Within the patients who were referred to our outpatient clinic, the number of those detected with a ventricular septal defect location and size of the defect, the complications it caused, the possibility of medical, surgical or spontaneous closure were examined and it has been compared with our pre-pandemic data whether there is a difference in the number of routine outpatient clinic examinations and the rate of diagnosis of ventricular septal defect under the conditions of the Covid-19 pandemic. Material and Method The results of transthoracic echocardiography made between the years 2018-2022 were evaluated which were performed due to hearing a cardiac murmur during routine examination of patients with symptoms such as chest pain, palpitations, fatigue, difficulty breathing, fainting, or any non-cardiac complaint. Results Ventricular septal defect was observed in 91 of 16362 patients (group 1) who underwent echocardiography between 2018 and 2020 before the pandemic, and in 202 of 14248 patients (group 2) who underwent echocardiography between 2020 and 2022, during the pandemic period. It is significant in that the patient rate is higher (p <0.001). Various complications may develop during the follow-up of ventricular septal defects. Considering the total number of complications, they were statistically significantly higher in the prepandemic period (p=0.003). However, when the developing complications were evaluated separately, a significant difference was detected only in terms of ventricular septal aneurysm development, with a higher rate in the pre-pandemic group (p=0.002). No significant difference was found in terms of other complications. Conclusion The similar number of patients has proven to us that there is no serious decrease in the number of pediatric cardiology outpatient clinic admissions, even under pandemic conditions. However, the higher frequency of diagnosis of ventricular septal defect during the pandemic period may be due to the fact that patients who actually require pediatric cardiology examination applied to the hospital during this period.

Keywords

• Complications
• COVID-19 pandemic and VSD Spontaneous closure
• Ventricular septal defect (VSD)

References

1. 1. Hofman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39:1890–1900
2. 2. Eroğlu AG, Oztunç F, Saltik L, Bakari S, Dedeoğlu S, Ahunbay G. Evolution of ventricular septal defect with special reference to spontaneous closure rate, subaortic ridge and aortic valve prolapse. Pediatr Cardiol 2003;24:31–35
3. 3. Erdem S, Ozbarlas N, Küçükosmanoğlu O, Poyrazoğlu H, Salih OK. Long term follow-up of 799 children with isolated ventricular septal defects. Turk Kardiyol Dern Ars 2012; 40:22–25
4. 4. Karadas U, Saylam G, Yılmaz N, Kir M, Kizilca Ö, Demircan T et al. Assessment of ventricular septal defects by real-time three-dimensional echocardiography and comparison with surgical measurements. Progress in Pediatric Cardiology 2022;66:10156
5. 5. Kazmi U, Sadiq M, Hyder SN. Pattern of ventricular septal defects and associated complications. J Coll Physicians Surg Pak 2009;19:342–345
6. 6. Chaudhry TA, Younas M, Baig A. Ventricular septal defect and associated complications. J Pak Med Assoc 2011; 61:1001–1004
7. 7. Cox K, Algaze-Yojay C, Punn R, Silverman N, The Natural and Unnatural History of Ventricular Septal Defects Presenting in Infancy: An Echocardiography-Based Review. Journal of the American Society of Echocardiography 2020;33(6):763-770
8. 8. Chivers S, Lotto AA. Isolated Ventricular Septal Defect. In: Raja, S. (eds) Cardiac Surgery. Springer, 2020;849–863

9. 9. Adan A, Eleyan L, Zaidi M, Ashry A, Dhannapuneni R, Harky A, Ventricular septal defect: diagnosis and treatments in the neonates: a systematic review. Cardiology in the Young 2021;31(5):756 - 761
10. 10. Atalay S, Tutar E, Ekici F, Naçar N. Spontaneous closure of small apical muscular ventricular septal defects. The Turkish Journal of Pediatrics 2005;47:247-250
11. 11. Zhang J, Ko JM, Guileyardo JM, Roberts WC. A review of spontaneous closure of ventricular septal defect. Proc Bayl Univ Med Cent 2015;28(4):516-20.
12. 12. Sun J, Sun K, Chen S, Yao L, Zhang Y. A new scoring system for spontaneous closure prediction of perimembranous ventricular septal defects in children. PLoS One 2014;9(12);e113822
13. 13. Wu MH, Wang JK, Lin MT et al. Ventricular septal defect with secondary left ventricular-to-right atrial shunt is associated with a higher risk for infective endocarditis and a lower late chance of closure. Pediatrics 2006;117:e262–e267
14. 14. James H. Moller and Julian I.E.Hoffman. Ventricular septal defects. In: Daniel J. Penny. Pediatric Cardiovascular Medicine (2th Ed). Wiley & Blackwell, 2012;328-342.
15. 15. Miyake T, Shinohara T, Inoue T, Marutani S, Takemura T. Spontaneous closure of muscular trabecular ventricular septal defect: comparison of defect positions. Acta Paediatr 2011;100:e158–e162
16. 16. Xinyang L, Ren W, Song G, Zhang X. Prediction of spontaneous closure of ventricular septal defect and guidance for clinical follow-up. Clinical Cardiology 2019; 42:536–541.
17. 17. Zhao Q, Niu C, Liu F, Wu L, Ma X, Huang G. Spontaneous Closure Rates of Ventricular Septal Defects 6750 Consecutive Neonates. The American Journal of Cardiology 2019;124(4):613-617
18. 18. Miyake T. A review of isolated muscular ventricular septal defect. World Journal of Pediatrics 2020;16:120–128
19. 19. Gelehrter S, Ensing G. Ventricular septal defect, In: Echocardiography in Pediatric and Adult Congenital Heart Disease. USA Lippincott Williams & Wilkins, 2010;158-175
20. 20. Stout K, Daniels C , Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, at all. AHA/ACC Guideline for the Management of Adults with Congenital Heart Disease. Journal Of The American College Of Cardiology 2018;73:12
21. 21. Park MK. Ventricular septal defect. In: Pediatric Cardiology for Practitioners (5.th Ed), Philadelphia, Mosby Elsevier, 2008; 212-221
22. 22. Rubio A, Lewin M. Ventricular Septal Defects. In: Moss and Adams’ Heart Disease in Infants, Children, and Adollescents (8th.Ed) USA Lippincott Williams & Wilkins, 2013; 713-721
23. 23. Meberg A, Otterstad JE, Frøland G, Lindberg H, Sørland SJ. Outcome of congenital heart defect-a population-based study. ActaPaediatr 2000; 89:1344–1351
24. 24. Bernstein D. Ventricular Septal Defects. In: Nelson Textbook of Pediatrics (19th Ed) USA Elsevier Saunders, 2011;1556-1559
25. 25. Erol O, Sevket O, Keskin S, Yazıcıoğlu HF, Gül A. Natural history of prenatal isolated muscular ventricular septal defects. J Turk Ger GynecolAssoc 2014;15:96–99
26. 26. Miyake T, Shinohara T, Nakamura Y, Fukuda T, Hasato T, Toyohara K et al. Aneurysm of the Ventricular Membranous Septum: Serial Echocardiographic Studies. Pediatr Cardiol 2004;25:585–589.
27. 27. Ramaciotti C, Keren A, Silverman NH. Importance of perimembranous ventricular septal aneurysm in the natural history of isolated perimembranous ventricular septal defect. Am J Cardiol 1986; 57:268–272
28. 28. Wu MH, Wu JM, Chang C et al. Implication of aneurysmal transformation in isolated perimembranous ventricular septal defect. Am J Cardiol 1993;72:596–601
29. 29. Wu MH, Wang JK, Lin MT et al. Ventricular septal defect with secondary left ventricular -to -right atrial shunt is associated with a higher risk for infectiv eendocardit is and a lower late chance of closure. Pediatrics 2006; 117:e262–e267
30. 30. WHO. Coronavirus disease (COVID-19) Situation Report-128 Data as received by WHO from national authorities by 10:00 CEST-27 May 2020. [Internet]. Available from: https://www. who.int/docs/default-source/coronaviruse/situation-reports/ 20200622-covid-19-sitrep-154
31. 31. T.C. Sağlık Bakanlığı. COVID-19 Bilgilendirme Platformu [Internet]. Available from: https://covid19bilgi.saglik.gov.tr/tr/
32. 32. T.C. Sağlık Bakanlığı. COVID-19 (SARS-CoV2 Enfeksiyonu) Rehberi (Bilim Kurulu Çalışması) [Internet] T.C. Sağlık Bakanlığı. Nisan 2020. Available from: https://covid19bilgi.saglik.gov. tr/tr/
33. 33. Bakhshi H, Gattani R, Ekanem E, at al. Ventricular septal rüptüre and cardiogenic shock complicating STEMI during COVID- 19 pandemic: An old foere-emerges. Heart&Lung, 2020; 50(2), 292–295.
34. 34. Miyake T, Shinohara T, Fukuda T, Ikeoka M, Takemura T. Spontaneous closure of perimembranous ventricular septal defect after school age. Pediatr Int 2008 50:632–6
35. 35. Forbus GA, Shirali GS. Anomalies of the Ventricular Septum. In:Echocardiography in Pediatric and Congenital Heart Disease From Fetus to Adult. USA, Wiley-Blackwell, 2009;175-187
36. 36. Weng KP, Huang SH, Lin CC, Huang SM, Chien KJ, Ger LP, Hsieh KS. Re appraisal of left ventricular to right atrial (LV-RA) shunt in pediatric patients with isolated perimembranous ventricular septal defect. Circ 2008; J 72:1487
37. 37. Layangool T, Kirawittaya T, Sangtawesin C, Kojaranjit V, Makarapong P, Pechdam- rongsakul A. Natural aortic valve complications of ventricular septal defect: a prospective cohort study. J Med Assoc Thai 2008;91 Suppl 3:S53-9.
38. 38. Tweddell JS, Pelech AN, Frommelt PC, Ventricular Septal Defect and Aortic Valve Regurgitation: Pathophysiology and Indications for Surgery. Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2006;9(1):47-152
39. 39. Eroglu AG, Ugan Atik S, Sengenc E, Cig E, Saltik IL, Oztunc F, Evaluation of Ventricular Septal Defect with Special Reference to the Spontaneous Closure Rate, Subaortic Ridge, and Aortic Valve Prolapse II.Pediatr Cardiol 2017; 38:915–921
40. 40. Dakkak W, Oliver T, Ventricular Septal Defect, In: StatPearls Publishing, Treasure Island (FL). 2023. PMID: 29261884