Sun et al reported a score for predicting spontaneous closure of a perimembranous ventricular septal defect (VSD). The authors are from Shanghai Jiaotong University and Shanghai Children's Medical Center.
Patient selection: perimembranous ventricular septal defect (PMVSD)
Parameters:
(1) initial contact age in years
(2) VSD diameter in cm
(3) number of associated complications (LV to RA shunt, suboaortic ridge, aortic valve prolapse, hypertrophy of right ventricular outflow tract)
(4) diffuse shunt flow
(5) grade of aneurysmal tissue of the ventricular membranous septum (ATVMS)
(6) increase in left ventricular end-diastolic dimensions (LVDD)
|
Parameter |
Finding |
Points |
|
age initial contact |
<= 1 year |
4 |
|
|
1.01 to 2 years |
2 |
|
|
2.01 to 3 years |
0 |
|
|
3.01 to 4 years |
-2 |
|
|
4.01 to 5 years |
-4 |
|
|
5.01 to 6 years |
-6 |
|
|
>= 6.01 years |
-8 |
|
VSD diameter |
<= 0.3 cm |
5 |
|
|
0.31 to 0.6 cm |
3 |
|
|
0.61 to 0.9 cm |
0 |
|
|
0.91 to 1.2 cm |
-3 |
|
|
>= 1.21 cm |
-5 |
|
number of complications |
0 |
0 |
|
|
1 |
-5 |
|
|
>= 2 |
-10 |
|
diffuse shunt flow |
no |
0 |
|
|
yes |
-1 |
|
grade ATVMS |
Grade 0 |
0 |
|
|
Grade 1 |
3 |
|
|
Grade 2 |
5 |
|
increased LVFF |
no |
0 |
|
|
yes |
-1 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -25
• maximum score: 14
|
Total Score |
3-Year Percent Spontaneous Closure |
|
-10 to -25 |
< 0.2% |
|
-9 |
0.2% |
|
-8 |
0.3% |
|
-7 |
0.4% |
|
-6 |
0.6% |
|
-5 |
0.8% |
|
-4 |
1.1% |
|
-3 |
1.5% |
|
-2 |
2% |
|
-1 |
2.7% |
|
0 |
3.6% |
|
1 |
4.8% |
|
2 |
6.5% |
|
3 |
8.7% |
|
4 |
11.6% |
|
5 |
15% |
|
6 |
20% |
|
7 |
26% |
|
8 |
34% |
|
9 |
43% |
|
10 |
53% |
|
11 |
64% |
|
12 |
75% |
|
13 |
85% |
|
14 |
92% |
Performance:
• The area under the ROC curve is 0.83 in the derivation and 0.86 in the validation cohorts.
Specialty: Cardiology
