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Long-term complications following surgical patch closure of multiple muscular ventricular septal defects

Lou Hofmeyr1, Peter Pohlner, Dorothy J Radford

  • 1Adult Congenital Heart Disease Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia.

Congenital Heart Disease
|January 29, 2013
PubMed

Insights

Surgical closure of muscular ventricular septal defects (VSD) using RV apical exclusion shows good initial outcomes. However, long-term adult follow-up reveals complications like right heart failure and arrhythmias due to reduced RV size and diastolic dysfunction.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Adult Congenital Heart Disease

Background:

  • Muscular ventricular septal defects (VSDs) in children present treatment challenges.
  • Surgical techniques for VSDs include pulmonary artery banding, catheter closure, and various surgical approaches.
  • Apical muscular VSDs with coarse trabeculations may require patches excluding the right ventricle (RV) apex.

Observation:

  • Four adult patients, operated on 22-45 years prior for muscular VSD with RV apical exclusion, were assessed.
  • Patients presented with polycythemia, cyanosis, syncope, and atrial flutter.
  • Echocardiography revealed bidirectional flow, small RV with diastolic dysfunction, enlarged right atria, and patent foramen ovale (PFO) reopening in three patients.

Findings:

  • Long-term follow-up in adulthood identified complications including cyanosis, right heart failure, hepatic cirrhosis, and arrhythmias.
  • Reduced RV size and diastolic dysfunction were noted in patients with prior RV apical exclusion surgery.
  • Catheterization confirmed elevated right atrial and RV end-diastolic pressures, with right-to-left shunting in two patients.

Implications:

  • While RV apical exclusion for muscular VSD offers early success, long-term adverse effects necessitate careful monitoring.
  • Adults previously treated with this technique may develop significant cardiac and systemic complications.
  • Further research is needed to optimize surgical strategies for muscular VSDs to improve long-term outcomes.
Abstract

Keywords:
Adult Congenital Heart DiseaseMultiple Ventricular Septal DefectsMuscular Ventricular Septal DefectsPatch Closure of Ventricular Septal Defects“Swiss Cheese” Ventricular Septal Defects

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