Congenital isolated apical ventricular septal defects.

The diagnosis of apical ventricular septal defects (VSDs) is difficult and the ratio of spontaneous closure is not well known. At the Ankara University Pediatric Cardiology Department, between the years 1992 and 1997, 33 patients were identified by color-flow Doppler (CFD) imaging as having a small defect at the apical portion of the ventricular septum. The age range was 1 day to 13 years. All patients were asymptomatic with normal telecardiograms and electrocardiograms. There were grade 2-3/6, pansystolic murmurs at the apex or closer to the apex in 19 patients. In 30 patients, narrow and short colored jets were seen at the apex of the heart, distal to the moderator band. The jets were wide in three patients. These defects were difficult to image and required specific angulation of the transducer. Of the 23 patients who had follow-up examinations, at 3 months to 3.5 years, there was spontaneous closure in ten (43.5%). To the authors' knowledge, this report is the largest series of isolated apical trabecular ventricular septal defects (t-VSDs). In their experience, color-flow imaging is more sensitive in detecting a small apical VSD. They conclude that although the closure of apical VSD is not the rule, the prognosis is excellent.