A New Scoring System for the Prediction of Spontaneous Closure of Perimembranous Ventricular Septal Defect in Children

  • Dr Jing Sun, Department of Pediatric Cardiology, Shanghai Children's Medical Center, China
  • Dr Kun Sun, Department of Pediatric Cardiology, Shanghai Children’s Medical Center, China
  • Dr Lanping Wu, Department of Pediatric Cardiology, Shanghai Children's Medical Center, China
  • Dr Liping Yao, Department of Pediatric Cardiology, Shanghai Children's Medical Center, China
  • Dr Xiao Tan, Department of Pediatric Cardiology, Shanghai Children's Medical Center, China
  • Dr Yuqi Zhang, Department of Pediatric Cardiology, Shanghai Children's Medical Center, China
  • Dr Juan Qian, Department of Pediatric Cardiology, Shanghai Children's Medical Center, China
  • Dr Zhifang Zhang, Department of Pediatric Cardiology, Shanghai Children's Medical Center, China

    • Objective: Perimembranous ventricular septal defect (PMVSD) has a relative high rate of spontaneous closure, but there are still a lot of patients with PMVSD could not get closed spontaneously. Our aim was to develop a new scoring system for the prediction of spontaneous closure of PMVSD.
    Methods: Eleven variables of 1873 well followed patients diagnosed with PMVSD were analyzed with logistic regression for their effects on the rate of spontaneous closure. The variables confirmed to significantly contribute to spontaneous closure of PMVSD were selected and their coefficients were calculated to establish the scoring system for predicting spontaneous closure of PMVSD. The chances of spontaneous closure of 406 cases diagnosed with PMVSD were predicted prospectively using the scoring system to evaluate its feasibility.
    Results: Seven variables (first contact age, defect size, extending orientation, shunt flow, aneurysm of the ventricular membranes septum, complications, left ventricular diastolic dimension) were found to have significant effects on spontaneous closure of PMVSD according to multivariate analysis and selected to establish a new scoring system based on their coefficients. Patients with higher scores seemed to have higher spontaneous closure rate in the new scoring system. For the 406 cases, the accuracy of the scoring system was 78.6%.
    Conclusions: The probability of spontaneous closure of PMVSD could be predicted by this scoring system. Patients with low probability could be informed earlier and scheduled for intervention appropriately. However, patients having high probability could be followed intensively waiting for spontaneous closure and the excessive operations could be avoided.