Anatomic evidence for spontaneous closure of ventricular septal defect.

T HE PROBABILITY that postnatal spontaneous closure of ventricular septal defect occurs with some frequency has been evident to clinicians for a number of years. This postulate is based upon the presence of characteristic murmurs in childhood which disappear with the growth and development of the patient.1-7 Convincing evidence of spontaneous functional closure of ventricular septal defects is found in several recent reports of serial cardiac catheterization in children.8-13 Hoffman and Rudolph (personal communication) studied by serial cardiac catheterization 40 infants with ventricular septal defect. They observed that while the size of the defect did not appear to change in 11, it either closed or became smaller in 29 cases. In 10 of these 29 cases, there was evidence of closure of the ventricular septal defect. Ventricular septal defects constitute about 20% of all isolated congenital cardiac malformations in children but only 7% of the congenital defects in adults. This difference cannot be explained because of early mortality in those with ventricular septal defect.14 15 In spite of these observations which suggest the phenomenon of spontaneous closure of ventricular septal defect, description of closed ventricular septal defects is limited to a few isolated reports.