Ventricular Septal Defect in Adults: Analysis of Survival with and Without Interventional Procedures. The Relevant Role of Echocardiography

Abstract

Background: Ventricular septal defects (VSDs) are one of the most common congenital heart defects, although many close spontaneously by adulthood. The main aim of this investigation was a) to investigate by echo the best cutoff value of pulmonary artery systolic pressure (PASP) in relation to VSD size, for defining the surgical or interventional treatment (SIT), b) to compare medical versus SIT results and c) to analyze morbidity and mortality of adults with VSDs. Material: 193 patients aged ≥16 years with VSDs were studied. All had a complete clinical examination, electrocardiogram, chest x-ray and transthoracic echocardiography. Fifty three (27.5%) patients underwent cardiac catheterization. Results: Seventy (36.3%) were asymptomatic, 119 (61.7%) had cardiomegaly, and 124 (64.2%) pulmonary artery hypertension (PAH). The PASP in small defined VSDs was 38 ± 19, and in large it was 69 ± 34 mmHg. Twenty one (11%) developed Eisenmenger syndrome (ES). The best cutoff point for PASP was 65 mmHg. The coefficient of correlation between VSD size and degree of PASP was 0.64 (p ≤0.000). Forty-five patients had surgical and 10 interventional VSD closure. The patients who underwent SIT had better survival than those who received medical treatment (P <0.000). There were 32 (16.6%) cardiac deaths. Conclusions: VSD in adulthood is symptomatic in the majority of cases. The best cutoff point for PASP was 65 mmHg for defining SIT. There were 32 (16.6%) deaths during the follow-up period. Patients with ES had a poor prognosis. Patients who underwent SIT had better survival than those who received medical treatment.