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Ahmad, Ammar (2009) Natural and Unnatural History of Isolated Ventricular Septal Defects in a Paediatric Population: A Longitudinal Retrospective Study. [Tesi di dottorato]

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Abstract (inglese)

This study shows the rate of spontaneous closure of various types of ventricular septal defects over time, 519 patients with VSD had been studied and followed by time, the spontaneous closure(SC) had been documented in 80% (185/232) of all muscular defects, in 22%(62/279) of perimembranous defects, one case(1/8, 12%) of subpolmonary defects. the SC had been registered in 19 of patients by age of 6 months, in 50% of cases by age between 1-2 years , in 77 % of patients between 2-4 years , and in 97 % by age between 6 and 10 years. in patients without congestive heart failure(CHF), the rate of SC was 50%, the SC had been registered in (12/74) 16% of patients with CHF. this observation suggest un conservative attitude in the first months of life, unless a pulmonary hypertension is developed. surgery is quite safe ( we haven’t considered the per operative mortality), although sever complications like complete a-v block was verified in 2% of cases, VSD residual in 14% of cases with the necessity of re-intervention in 1% of cases , we contend that the SC, probably, occur by the growth of muscular septum around the defect, this explain why muscular defects close before membranous VSD, like we have demonstrated in our study.

Abstract (italiano)

Questo studio dimostra il rateo della chiusura spontanea (CS) di vari tipi di difetti interventricolari (DIV) col tempo. Abbiamo seguito 519 pazienti con DIV negli anni. la chiusura spontanea è stata documentata in 80% (185/232) di difetti intermusculari, in 22% (62/279) di difetti perimembranosi, in unico caso (1/8, 12%)di difetti sub polmonari. la CS è stata registrata in 19% dei pazienti di età di 6 mesi, in 50% dei casi di età fra 1-2 anni, in 77% di età fra 2 a 4 anni, e in 97% di età fra 6 a 10 anni. In pazienti senza scompenso cardiaco, il rateo di CS era 50%, mentre era 16% nei pazienti con scompenso cardiaco.
Tale osservazione suggerisce un atteggiamento conservativo nei primi mesi di vita, salvo la presenza di ipertensione polmonare . la chirurgia è completamente sicura (non abbiamo preso la mortalità chirurgica in considerazione), nonstante le complicazioni severe come il blocco completo atrio-ventricolare che è verificato in 2% dei casi. DIV residui in 14%dei casi, con la necessità di re-intervenire in 1% dei casi. Noi sosteniamo che la CS probabilmente si avviene in seguito di crescità del setto musculare intorno il difetto, quello che spiega perche i difetti musculari si chiudono prima dei difettti perimembranosi, come abbiamo dimostrato nel nostro studio.

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Tipo di EPrint:Tesi di dottorato
Relatore:Milanesi, Ornella
Dottorato (corsi e scuole):Ciclo 20 > Scuole per il 20simo ciclo > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > SCIENZE CARDIOVASCOLARI
Data di deposito della tesi:28 Gennaio 2009
Anno di Pubblicazione:28 Gennaio 2009
Parole chiave (italiano / inglese):VSD, spontaneous closure, natural history
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/38 Pediatria generale e specialistica
Struttura di riferimento:Dipartimenti > Dipartimento di Scienze Medico Diagnostiche e Terapie Speciali
Codice ID:1511
Depositato il:28 Gen 2009
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