[Ventricular septal defects: anatomic, clinical, therapeutic and prognostic aspects. 44 cases].

Objectives: The aim of this study is to analyze epidemiologic, anatomic, clinical and prognostic aspects of ventricular septal defect (VSD) in the pediatric population in Morocco.

Methods: This retrospective descriptive study included 44 consecutive patients admitted to the cardiology B department of Rabat University Hospital Center from January 2000 through March 2003. The inclusion criteria were: VSD, isolated or associated with other left-right shunt defects, diagnosed by transthoracic echocardiography, and hospitalized in the service.

Results: VSD accounted for 10.6% of the congenital cardiac diseases hospitalized in our department. Patients' mean age was 2.25 +/- 2.6 years; the consanguinity rate was 29%. The primary clinical symptoms were dominated by failure to gain weight (84%), exertional dyspnea (82%), and repeated bronchitis (72%). Early complications were infundibular stenosis (4 cases), aortic regurgitation (3 cases), and infectious endocarditis (1 case). Nine children had other abnormalities, including 6 with trisomy 21. Echocardiography showed that membranous defects were by far the most common type (88%). All patients received symptomatic medical treatment. Only 31.7% (n=14) had surgery: 11.3% (n=5) to close the hole (corrective) and 20.4% (n=9) for pulmonary artery (palliative) banding. After two years of follow-up, those with surgical correction were all doing well.

Conclusion: Surgically closing the VSD is the best way to avoid irreversible pulmonary arterial hypertension; banding should be only a temporary measure while awaiting corrective surgery.