Congenital heart diseaseBehavior of Unrepaired Perimembranous Ventricular Septal Defect in Young Adults
Section snippets
Methods
All patients, registered with an unrepaired pmVSD at 16 years of age, were selected from our database of pediatric and congenital cardiology. It contains >20,000 patients with congenital heart defects. Of these patients, 7,000 are >16 years old. Our department of pediatric and congenital cardiology yearly performs >300 interventional catheterizations, and >200 patients are referred to the congenital cardiac surgeon. Only restrictive VSDs were allowed to be included. All patients in whom the
Results
A total of 220 patients were included in the present study. The median age at inclusion was 18 years (IQR 7). The patients (119 males, male/female ratio 1.18:1) were followed for a median of 6 years (IQR 4, range 38). At the end of the study, the median age of the study cohort was 27 years (IQR 11). The demographic clinical, echocardiographic, and hemodynamic characteristics are summarized in Table 1.
Two patients (1%) died during the follow-up period. One patient, with congestive cardiomyopathy
Discussion
We found that the course of patients with an unclosed and small pmVSD at the age of 16 years was not uneventful. Although the pmVSD closed spontaneously in some patients, others required surgical or interventional repair at later follow-up. Moreover, patients with persistent open pmVSD during follow-up developed significant echocardiographic and electrophysiologic changes.
We observed spontaneous pmVSD closure in 4% of our patients >16 years. Of all VSDs 11% to 70.8% close spontaneously during
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Cited by (44)
Canadian Cardiovascular Society 2022 Guidelines for Cardiovascular Interventions in Adults With Congenital Heart Disease
2022, Canadian Journal of CardiologyCitation Excerpt :Patients with an isolated VSD that is surgically repaired in childhood and those with small restrictive (without significant shunt) VSDs not requiring repair, have an excellent long-term prognosis, although they are not completely free from morbidity or mortality (Fig. 3). Of patients with restrictive VSD deemed not to require surgical closure during childhood, long-term survival is expected and favourable.60-62 Occasionally, isolated VSDs are not identified in childhood and might subsequently present in adulthood with left ventricular (LV) volume overload, infective endocarditis, progressive aortic regurgitation (AR), or PAH.
Interventions in Congenital Heart Disease: A Review of Recent Developments: Part II
2021, Structural HeartCardiopulmonary dysfunction in adults with a small, unrepaired ventricular septal defect: A long-term follow-up
2020, International Journal of CardiologyCitation Excerpt :Early observational studies suggested that cardiopulmonary capacity in adults with small, unrepaired VSD's is comparable to that of healthy individuals [22–24]. However, the studies lacked a reference group of healthy controls, and had a relatively short follow-up time and more recent papers report adverse late cardiovascular performance among these patients [1–3,25] supporting the notion that these defects may not be as benign as previously thought. Our prior results [5] showing lower exercise capacity in these patients may be important, as cardiorespiratory fitness is a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women [26].
Transcatheter closure of a perimembranous ventricular septal defect with Nit-Occlud Lê VSD Coil: A French multicentre study
2020, Archives of Cardiovascular DiseasesCitation Excerpt :Previously, most pmVSD in patients without heart failure or pulmonary hypertension (type I and type IIa) were not closed to avoid surgery. In recent years, some studies have shown that adults with these defects have a higher risk of endocarditis, left ventricular diastolic dysfunction, supraventricular arrhythmia and pulmonary hypertension [9–12]. In the same timeframe, other devices have appeared as alternatives to the historic Amplatzer device to close pmVSD, e.g. Amplatzer Duct Occluder 1, Amplatzer Duct Occluder II, Amplatzer Vascular Plug II (Abbott, Chicago, USA), Nit-Occlud Lê VSD Coil (PFM, Koln, Germany) and Cera duct occluder (Lifetech, Shenzen, China) [13–19].
Heart rate variability is impaired in adults after closure of ventricular septal defect in childhood: A novel finding associated with right bundle branch block
2019, International Journal of CardiologyCitation Excerpt :For both of the latter two groups, the long-term implications have traditionally been considered to be benign [2–6]. However, there is emerging evidence of late morbidity in adults with a surgically closed VSD [7–11] and also in patients with small, open defects [12–15]. In particular, studies on adults operated for VSD have indicated ncreased pulmonary vascular resistance, especially during exercise [9, 10, 16, 17].
Insurability of adults with congenital heart disease
2018, Diagnosis and Management of Adult Congenital Heart Disease: Third Edition