Survival and outcomes of isolated neonatal ventricular septal defects: A population-based study from a middle-income country

Abstract

ABSTRACT Background and Aims: Limited data on the survival and outcomes of ventricular septal defect (VSD) in middle-income countries are available. Hence, this study aims to determine the survival and factors associated with mortality among neonatal VSD. Materials and Methods: This is a retrospective, population based study of neonates with isolated VSD born between 2009 and 2019. Kaplan–Meier analysis was used to estimate the overall survival. Cox regression analysis was used to determine factors associated with mortality. Results: There were 726 patients studied, with 82 (11%) of them having trisomy 21. The median age of diagnosis and follow-up was 5 days (interquartile range [IQR]: 2–10 days) and 2.3 years (IQR: 0.6–4.8 years), respectively. Of 726, 399 (55%) were perimembranous, 218 (30%) muscular, and 109 (15%) outlet VSD. VSD was small in 309 (42%), moderate in 337 (46%), and large in 80 (11%). Of 726 patients, 189 (26%) had congestive heart failure (CHF) and 52 (7.2%) developed pulmonary hypertension (PHT). Interestingly, one-third of CHF and PHT resolved over time during follow-up. Only 1 (0.1%) patient had infective endocarditis, 38 (5.2%) developed aortic regurgitation, and none had Eisenmenger syndrome. Overall, 149 (20%) needed surgery, 399 (55%) spontaneously closed, and 178 (25%) remained small. The mortality rate was 3.9% (28), 16 (57%) preoperatively, and 11 (39%) due to pneumonia. Trisomy 21, PHT, and birth weight <2.5 kg were independent factors for mortality with an adjusted hazard ratio of 6.0 (95% confidence interval [CI]: 2.1–16.9), 3.2 (95% CI: 1.2–8.4), and 3.6 (95% CI: 1.7–7.8), respectively. The overall survival at 1, 5, and 10 years was 96% (95% CI: 95–98), 95% (95% CI: 94–97), and 95% (95% CI: 94–97), respectively. Conclusions: Despite limited pediatric and congenital cardiac services in middle-income countries, the overall survival of neonatal VSD is good, with poor outcomes in small infants, PHT, and trisomy 21.