Clinical utility of the ventricular septal defect diameter to aorta root diameter ratio to predict early childhood developmental defects or lung infections in patients with perimembranous ventricular septal defect

Relation of Macrophage Migration Inhibitory Factor to Pulmonary Hemodynamics and Vascular Structure and Carbamyl-Phosphate Synthetase I Genetic Variations in Pediatric Patients with Congenital Cardiac Shunts

Macrophage migration inhibitory factor (MIF) plays an important pathophysiological role in pulmonary hypertension (PHT). Previously, we demonstrated that serum MIF is increased in pediatric PHT associated with congenital heart disease (CHD). In the present study, we determined possible associations between MIF levels, hemodynamic and histological parameters, and mitochondrial carbamyl-phosphate synthetase I (CPSI) T1405N polymorphism in a similar population. The asparagine 1405 variant (related to A alleles in the C-to-A transversion) has been shown to be advantageous in pediatric PHT compared to the threonine 1405 variant (C alleles). Forty-one patients were enrolled (aged 2-36 months) and subsequently divided into 2 groups after diagnostic evaluation: the high-pulmonary blood flow (high PBF) group (pulmonary-to-systemic blood flow ratio 2.58 (2.21-3.01), geometric mean with 95% CI) and the high-pulmonary vascular resistance (high PVR) group (pulmonary vascular resistance 6.12 (4.78-7.89) Wood units × m²). Serum MIF was measured using a chemiluminescence assay. The CPSI polymorphism was analyzed by polymerase chain reaction followed by high-resolution melting analysis. Medial hypertrophy of pulmonary arteries was assessed by the histological examination of biopsy specimens. Serum MIF was elevated in patients compared to controls (p = 0.045), particularly in the high-PVR group (n = 16) (p = 0.022) and in subjects with the AC CPSI T1405N genotype (n = 16) compared to those with the CC genotype (n = 25) (p = 0.017). Patients with high-PVR/AC-genotype profile (n = 9) had the highest MIF levels (p = 0.030 compared with the high-PBF/CC-genotype subgroup, n = 18). In high-PVR/AC-genotype patients, the medial wall thickness of intra-acinar pulmonary arteries was directly related to MIF levels (p = 0.033). There were no patients with the relatively rare AA genotype in the study population. Thus, in the advantageous scenario of the asparagine 1405 variant (AC heterozygosity in this study), heightened pulmonary vascular resistance in CHD-PHT is associated with medial hypertrophy of pulmonary arteries where MIF chemokine very likely plays a biological role.

Factors influencing the spontaneous closure of ventricular septal defect in infants

This study is to prospectively evaluate the potential value of maternal and infantile variables as predictors for the spontaneous ventricular septal defects (VSD) closure in infants.

METHODS

Consecutive infants less than six-month-old when diagnosed with VSD, were followed-up for at least 5 years. Demographic, clinical and maternal factors were evaluated for the possible associations of the incidence of spontaneous VSD closure Of the 425 eligible infants, 93 had spontaneous VSD closure, 78.50% of which occurred when the patients were under 3 years of age. Diameter of the defect (DVSD), ratio between diameter of the defect and aortic root diameter (DVSD/DAR), left atrium sizes, left ventricle sizes, main pulmonary forward blood flow, infection scores, shunt ratio (Qp/Qs), VSD locations, and comorbidities including patent ductus arteriosus (PDA), and membranous septal aneurysm were independent predictors of spontaneous closure. However, maternal factors during the first 3 months of pregnancy and VSD infants with Down syndrome did not affect the spontaneous closure of infants with VSD.

CONCLUSION

DVSD, DVSD/DAR, left atrium sizes, left ventricle sizes, main pulmonary forward blood flow, infection scores, Qp/Qs, VSD location, comorbidities including PDA, or membranous septal aneurysm may be used as potential independent predictors of spontaneous VSD closure in infants.