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Long-term follow-up in isolated ventricular septal defect considered too small to warrant operation
J E Otterstad1, J Erikssen, S Michelsen
1Medical Department B, Rikshospitalet, Oslo, Norway.
Insights
Adults with small, isolated ventricular septal defects (VSDs) require close monitoring. Despite being initially deemed unnecessary, surgery was indicated for some, and complications arose in a significant portion of patients over time.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
Background:
- Isolated ventricular septal defects (VSDs) are congenital heart conditions.
- Management strategies for unoperated adult VSDs can vary.
Purpose of the Study:
- To assess the long-term outcomes and complications in adults diagnosed with isolated VSD.
- To determine the necessity of ongoing cardiac monitoring for this patient group.
Main Methods:
- A cohort of 70 adult patients with isolated VSD was followed for a mean of 21 years.
- Mortality and complication rates were compared to a matched normal group.
- Long-term clinical status, including dyspnea, chest pain, and medication use, was evaluated.
Main Results:
- 11 deaths occurred (15.7%), with 4 potentially VSD-related.
- 22% experienced major VSD-related complications, with 8 requiring cardiac surgery.
- Significant long-term symptoms included dyspnea (24%) and chest pain (22%).
Conclusions:
- Unoperated adults with small VSDs face a considerable risk of complications and should undergo close, regular cardiac monitoring.
- The condition is not benign and requires vigilant management throughout adulthood.
- A substantial percentage of patients develop symptoms or require interventions over the long term.
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.