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DETERMINANTS OF GROWTH IN PATIENTS WITH VENTRICULAR SEPTAL DEFECT

Growth status was assessed in 1210 patients(pts)with ventricular septal defect(VSD)participating in the Cooperative study on tho Natural History of Congenital Heart Disease. Height(Ht)and weight(Wt)maturation wore compared to the new National Center for Health Statistics norms. A total of 793 pts were managed medically; 194 underwent successful surgical repair, and 223 were surgically palliated, Mean follow-up period was 6.4 years (range 4 to 8 years). On initial assessment 77.0% of pts were below normal median Wt(X2=495, p<.001) and 67.8% below normal nedian Ht(x2=132, p<.001). Multivariate analysis revealed major significant determinants of Ht at initial assessment and after medical or surgical management to be birth Wt<2.5 kg(t=-6.5, p<.001), pulmonary/systemic pressure ratio(t=-4.8,n<., presence of extracardiac congenital anomalies (ECA) (t=-3.4, p<.001), and advancing age(t=+13.3, p<.001), Determinants of Wt were similar to those for Ht except for the additional influence of pulmonary/systemic flow(Qp/Qs) ratio(t=-4.5, p<.001). Mean Ht increased to the same extent independently of management, but remained subnormal (t=-8.9, p<.001). By contrast Ht status showed significantly greater gains after repair (t=+2.5, p<.01)with improvement to normal mean Wt. We conclude that growth in pts with VSD is strongly influenced by intrauterino growth, presence of ECA and hemodynamic abnormalities. Correction of abnormal hemodynamics improves growth if other relevant determinants are favorable.