الفهرس 
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Abstract
Introduction: The most common form of congenital heart disease in childhood is the VSD, occurring in 50% of all children with congenital heart disease (Moller, 1987) and in 20% as an isolated lesion.(Clark, 2001)
The size of the VSD, the pressure in the right and left ventricular chambers, and pulmonary resistance are factors that influence the hemodynamic significance of VSDs.
It is believed that MR in children with a normal mitral valve (MV) apparatus and hemodynamically large VSD resolves spontaneously after the surgical closure of VSD (Mahadin, 2011).
However, limited information is available on the relationship between MR and left heart volume overload. A higher degree of MR is supposed to be associated with more severe left heart dilation, and the reversibility of the myocardial damage might take a longer period with a more severe degree of left heart dilation.
Aim of the work: To evaluate improvement in LV function, LV dimensions, degree of MR and LA dimensions post-surgical correction of congenital VSD in pediatric age group.
Patients and methods:
The study included seventy three children with isolated congenital ventricular septal defect presenting to NHI as candidates for surgical closure of VSD who met inclusion criteria. All patients were subjected to: full history taking, clinical examination, complete echocardiographic analysis for the VSD, LV dimensions and function, LA dimensions and degree of MR.
Patients were classified into 3 groups according to the degree of MR as follows; group 1: no MR, group 2: trivial to mild MR, group 3: moderate, or severe MR.
All patients were brought for follow up visits at 1 and 3 months where TTE was repeated for: Adequacy of VSD closure, improvement of Left sided systolic function and internal dimensions, improvement of LA dimensions, and residual MR.
Results:
Mean age of patients was 3 ±3 years. About 52% were females, and 48% were males.
Seventy eight percent had perimembraneous VSD and 12% had outlet VSD, and 28.3% of patient had nonrestrictive VSD. Thirty percent of our patients had no mitral regurgitation, 40% had mild mitral regurgitation, 20% had moderate mitral regurgitation, and 6% had severe mitral regurgitation.
Degree of mitral regurgitation decreased significantly post-surgery at all grades of pre-surgical mitral regurgitation, probably due to reduction in LV volumes and mitral annular dilatation. There was an increase in ejection fraction postoperative follow up echocardiography. Significant progressive reduction in left ventricular end diastolic diameter in pre-discharge, 1 month, and 3 months follow up was also found.
from the present study we concluded that surgical closure of VSD in infancy results in improvement of Left ventricular ejection fraction and reduction of left ventricular dimensions, and this was shown with all degrees of preoperative mitral regurgitation.
With lower degrees of preoperative mitral regurgitation, improvement in left ventricular systolic function and dimensions is more rapid and significant.
There is improvement of degree of mitral regurgitation after surgical correction of ventricular septal defect.