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Inclusion Criteria
· Patients with VSD of any size with or without minor
Completion qualifies you for 1 hour of Category II CME credit. If you are taking this self-assessment as a
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Answer Key
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Evidence Ratings
We used the GRADE method of rating evidence quality. Evidence is first assessed as to
whether it is from randomized trial, or observational studies. The rating is then adjusted in the following manner:
Quality ratings are downgraded if studies:• Have serious limitations
• Have inconsistent results• If evidence does not directly address clinical questions• If estimates are imprecise OR
• If it is felt that there is substantial publication bias
Quality ratings can be upgraded if it is felt that:• The effect size is large• If studies are designed in a way that confounding would likely underreport the magnitude
of the effect OR• If a dose-response gradient is evident
Quality of Evidence: High quality
Moderate quality
Low quality
Very low quality
Expert Opinion (E)
Reference: Guyatt G et al. J Clin Epi 2011: 383-394
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Summary of Version Changes
· Version 1.0 (5/14/2014): Go live
· Version 2.0 (03/11/2015): Post-op inclusion and exclusion criteria updated
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Medical Disclaimer
Medicine is an ever-changing science. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy are required.
The authors have checked with sources believed to be reliable in their efforts to provide
information that is complete and generally in accord with the standards accepted at the time of
publication.
However, in view of the possibility of human error or changes in medical sciences, neither the
authors nor Seattle Children’s Healthcare System nor any other party who has been involved in
the preparation or publication of this work warrants that the information contained herein is in
every respect accurate or complete, and they are not responsible for any errors or omissions or
for the results obtained from the use of such information.
Readers should confirm the information contained herein with other sources and are encouraged
to consult with their health care provider before making any health care decision.
Bibliography
Studies were identified by searching electronic databases using search strategies developed and
executed by a medical librarian, Susan Klawansky. Scout and secondary searches were
performed in August and November 2013 in the following databases – on the Ovid platform:
Medline and Cochrane Database of Systematic Reviews; elsewhere: Embase, Clinical Evidence,
National Guideline Clearinghouse and TRIP. For the Scout search retrieval was limited to 1992-
current, English language and ages 0-18. In Medline and Embase, appropriate Medical Subject
Headings (MeSH) and Emtree headings were used respectively. The search strategy was
adapted for other databases as appropriate. The secondary searches on approximately 8 clinical
questions were limited to 2003 forward and all infants from birth-23 months. All retrieval was
further limited to certain evidence categories, such as relevant publication types, index terms for
study types and other similar limits.
May 1, 2014
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Bibliography
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Aydemir NA, Harmandar B, Karaci AR, Sasmazel A, Bolukcu A, Saritas T, et al. Results for surgical
closure of isolated ventricular septal defects in patients under one year of age. J Card Surg 2013
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Eroglu AG, Oztunc F, Saltik L, Bakari S, Dedeoglu S, Ahunbay G. Evolution of ventricular septal
defect with special reference to spontaneous closure rate, subaortic ridge and aortic valve prolapse.
Pediatr Cardiol 2003 Jan-Feb;24(1):31-35.
Halit V, Iriz E, Oktar GL, Olgunturk R, Kula S, Tunaoglu S, et al. The effects on pulmonary artery
pressure of early surgical repair of ventricular septal defect in small children. Gazi Med J 2008 /
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Hovels-Gurich HH, Konrad K, Skorzenski D, Nacken C, Minkenberg R, Messmer BJ, et al. Long-
term neurodevelopmental outcome and exercise capacity after corrective surgery for tetralogy of
Fallot or ventricular septal defect in infancy. Ann Thorac Surg 2006 Mar;81(3):958-966.
Matsuzaki T, Matsui M, Ichida F, Nakazawa J, Hattori A, Yoshikosi K, et al. Neurodevelopment in 1-
year-old Japanese infants after congenital heart surgery. Pediatr Int 2010 Jun;52(3):420-427.
Paul MA, Backer CL, Binns HJ, Mavroudis C, Webb CL, Yogev R, et al. B-type natriuretic peptide
and heart failure in patients with ventricular septal defect: a pilot study. Pediatr Cardiol 2009
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Simsic J, Phelps C, Yates A, Galantowicz M. Management Strategies After Cardiac Surgery in an
Infant With Human Rhinovirus. Pediatr Cardiol 2012 2012/:1-3.
Sondheimer HM, Rahimi-Alangi K. Current management of ventricular septal defect. Cardiol Young