Long‐term follow‐up in isolated ventricular septal defect considered too small to warrant operation

Abstract

An isolated ventricular septal defect (VSD) was diagnosed in 70 patients (39 men and 31 women, mean age 29 years, range 10-64 years). Surgery was judged unnecessary. The follow-up period was at least 10 years, or until death or 31 December 1988, comprising a mean duration of 21 (range 6-29) years. The mortality was 11/69 (one lost to follow-up), and was not significantly higher than in a matched 'normal' group. Six deaths were cardiac, four of which could probably be related to the VSD. The follow-up study revealed that: (1) 14 (22%) subjects had major, VSD-related complications, and cardiac surgery was indicated in eight patients; (2) six (10%) had minor complications. By the end of 1988, 24% of subjects had significant dyspnoea, 22% had chest pain and 19% used cardioactive drugs. Only 33% were receiving regular cardiac control in a hospital. Thus unoperated adults with a small VSD should be monitored closely, since this condition is far from benign.

Mortality and complications in 3495 children with isolated ventricular septal defects

“…In Norway, Otterstad et al 19 previously described increased mortality in 70 patients with small and unoperated VSDs born 1959–1978, which contrasts our findings. They reported 11 deaths until 1988.…”

Small Ventricular Septal Defect Considered Not Requiring Surgical Closure: The Frequency of Developing Complications in Our Center

“…5 Shah et al 23 estimated the risk of a 15-year-old with a VSD developing bacterial endocarditis by age 70 to be 11.5%. The highest percentage of 15% (5.7 per 1,000 patient-years) was reported by Otterstadet al 17 On the contrary, we found 0.8% echo based endocarditis in our patients.…”

“…16 Another follow-up study revealed that 22% subjects had major, VSD-related complications. 17 The natural history has a wide spectrum, ranging from spontaneous closure to congestive heart failure (CHF) to death in early infancy. 7 Spontaneous closure frequently occurs in children, usually by age of 2 years.…”

Initial experience with the amplatzer membranous septal occluder in adults

“…Recurrent bacterial endocarditis and hemodynamically important post surgery residual shunts are other indications for VSD closure in adulthood. (2)(3)(4)(5)(6)(7)(8)(9)(10).Surgical risk is increased in adults (19)(20)(21), and even more so, once they become symptomatic and clinically decompensated. When VSD closure is recommended to adults who are well, because of a gradual increase in size of the The device is shown in the same LAO-CR projection to be properly positioned in the pmVSD inferiorly (black arrow), but superiorly there is no rim of tissue to keep the left ventricular disk in position.…”

“…Still, some of them will need VSD closure in adulthood because of a moderate or large left to right shunt (Qp/Qs>1.5) causing left heart volume overload that results in heart failure, reduced exercise capacity or atrial fibrillation, or because of recurrent bacterial endocarditis. Some adults with previous surgery will need re-intervention due to a clinically important residual shunt (2)(3)(4)(5)(6)(7)(8)(9)(10).…”