Determinants of growth in patients with ventricular septal defect.

Abstract

Growth status was studied in 1210 patients with ventricular septal defects (VSD) participating in the Joint Study on the Natural History of Congenital Heart Defects. A total of 793 patients were managed medically and 194 underwent successful surgical repair. Admission measurements revealed height and weight status to be subnormal and related to physiological severity and age. Successful repair resulted in significant increase in weight but not height. Medical therapy was associated with little change in the subnormal growth pattern. Multivariate analysis revealed determinants of admission height for all patients with VSD to be presence of extracardiac anomalies, birthweight below 2.5 kg, admission age greater than 2 years, history of heart failure and pulmonary/systemic pressure ratio. The same determinants were noted for admission weight with addition of pulmonary/systemic flow ratio. It is conluded that the severe growth disturbance in patients with VSD is only in part due to abnormal postnatal hemodynamics. Intrauterine and genetic factors and low birthweight also play a role and help explain the incomplete growth response after successful surgery.