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Updated: Aug 31, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Follow-up after surgical closure of congenital ventricular septal defect
G Bol-Raap1, J Weerheim, A P Kappetein
1Department of Cardio-Thoracic Surgery, Erasmus MC Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Insights
Surgical closure of ventricular septal defects (VSDs) in children is safe. Most residual shunts close spontaneously within 3.9 years, avoiding reoperation. Tricuspid valve detachment (TVD) aids VSD exposure.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Surgery Outcomes
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Surgical VSD closure is a standard treatment.
- Assessing long-term outcomes after VSD repair is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term results of surgical VSD closure in pediatric patients.
- To determine the safety and efficacy of temporary tricuspid valve detachment (TVD) during VSD repair.
- To investigate the incidence and natural history of residual shunting after VSD surgery.
Main Methods:
- Retrospective analysis of 188 children undergoing VSD closure between 1992 and 2001.
- Comparison of outcomes between patients with and without temporary tricuspid valve detachment (TVD).
- Postoperative echocardiography and long-term clinical follow-up to assess residual shunting, regurgitation, and reoperations.
Main Results:
- No significant difference in cross-clamp time between TVD and non-TVD groups.
- Trivial or minimal tricuspid regurgitation occurred in 36% of patients, more frequent in the TVD group (22% vs. 40%, p=0.02).
- No residual VSDs required reoperation; trivial shunts resolved spontaneously in 51% by 3.9 years, and all by 8.4 years.
Conclusions:
- Surgical VSD closure is associated with favorable long-term outcomes.
- Temporary tricuspid valve detachment (TVD) is a safe adjunct for enhancing VSD exposure.
- Spontaneous closure of trivial residual shunts is common, obviating the need for reintervention.
Objectives:
The purpose of this retrospective study was to assess long-term outcome of children after surgical closure of a ventricular septal defect (VSD).
Material And Methods:
Between January 1992 and December 2001 a consecutive series of 188 patients (100 females) were operated for closure of a VSD. Temporary tricuspid valve detachment (TVD) was applied in 46 patients (24%) to enhance exposure of the defect using transatrial approach. Pre-operative baseline characteristics showed that the detached group was younger (0.79+/-1.8 vs 2.1+/-3.5 years, p=0.002) and had a lower weight (6.5+/-6.4 vs 10.0+/-11.0 kg, p=0.009).
Results:
There was no difference in cross-clamp time (temporary TVD 36.2+/-11.3 vs non-temporary TVD 33.6+/-13.1 min, p=0.228). Postoperative echocardiography showed that 67 patients (36%) had trivial/minimal regurgitation, 10 patients (22%) from the temporary TVD group vs 57 patients (40%) from the non-detached group (p=0.02). There was no tricuspid stenosis. Hospital mortality comprised two patients (1%). One patient died due to a pulmonary hypertensive crisis and one in relation to an acute patch dehiscence for which an emergency reoperation was necessary. At first postoperative echocardiography no shunting was detected in 113 patients, trivial shunting in 73 and significant shunting in none. Multivariate logistic regression analysis revealed that weight at operation was a predictive factor for the occurrence of residual shunting (OR 0.95, C.I. 0.91-0.99). One patient with conduction disturbances needed a permanent DDD-pacemaker. Three patients were lost to follow-up. Mean follow-up time was 2.6 years (range 0.1-9.4). During follow-up no reoperations were necessary for closing a residual VSD. One patient died 7 months postoperative due to a bronchopneumonia. During follow-up in 37 (51%) of the 73 patients the trivial shunting disappeared spontaneously at a median time of 3.9 years. According to actuarial analysis all trivial shunting had disappeared at 8.4 years.
Conclusion:
Trivial residual shunting disappeared spontaneously at a median follow-up time of 3.9 years. During follow-up no patient needed to be reoperated for residual VSD. TVD proved to be a safe method to enhance the exposure of a VSD.
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