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Surgery

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Thyroid & Adrenal

Question
52 out of 99
 

What is the best predictor of spontaneous closure of a ventricular septal defect (VSD):



A Size
B Age of diagnosis

C Gestational age
D Lack of ECG changes

Ans. B Age of diagnosis (Ref: Schwartz :Principles of surgery 5th edition page no. 803-04)

a. VSD is common congenital heart defect accounting for 20-30% of the all congenital defects.

b. Small defects should simply be observed as 60-70 percent of them will close in early life.

c. Over 50% of them will close by 3years.

d. Over 90% of them will be closed by the age of 8 years.

e. VSD may close or narrow spontaneously & the probability of closure is inversely related to the age at which the defect is detected.

f. This has an important impact on operative decision making, because a small or moderate size VSD may be observed for a period of time in absence of symptoms.

g. Closures most commonly occur with the membranous or muscular defects.

h. The treatment of the large defects depends pon the presence of the cardiac failure or increasing pulmonary vascular resistance.

i. Severe cardiac failure is fatal in infacy unless operation is performed in the first few weeks or months of life.

j. Banding of the pulmonary artery is was popularly used for such such critically ill patients but its nt practiced much now.

k. Infants with increased pulmonary resistance should be operated within 6 to 8 months of life.

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