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Long-term follow-up after ventricular septal defect repair in children: cardiac autonomic control, cardiac function
Ineke Nederend1,2, Eco J C de Geus1, Nico A Blom2
1Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Insights
Children with surgically repaired ventricular septal defects (VSD) show normal cardiac autonomic nervous system (ANS) activity but have reduced right ventricular function and exercise capacity years after surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Autonomic Nervous System Function
Background:
- Surgical repair of ventricular septal defects (VSD) offers good survival rates.
- Late complications are common in adults with congenital heart disease, but underlying mechanisms remain unclear.
- Altered cardiac autonomic nervous system (ANS) activity is a potential contributor to long-term sequelae.
Purpose of the Study:
- To comprehensively assess cardiac autonomic nervous system (ANS) activity in children long after VSD repair.
- To evaluate cardiac function and exercise capacity in these patients.
- To investigate potential links between ANS activity and cardiac function post-VSD repair.
Main Methods:
- 33 patients post-VSD repair and 66 healthy controls underwent 24-hour impedance cardiography for ANS and cardiac output monitoring.
- Detailed echocardiography was performed to assess cardiac function.
- Cardiopulmonary exercise testing evaluated exercise capacity.
Main Results:
- No significant differences in ambulatory cardiac ANS control were observed between VSD patients and controls.
- Patients exhibited decreased right ventricular function, exercise capacity, and ambulatory cardiac output compared to controls.
- No correlation was found between cardiac ANS activity and cardiac function in the studied cohort.
Conclusions:
- Long-term follow-up (average 9.9 years) after VSD repair reveals preserved cardiac ANS control but impaired right ventricular function and exercise capacity.
- These findings suggest that post-surgical outcomes for VSD may be less favorable than currently assumed.
- Continued adult follow-up is crucial for timely detection of adverse outcomes in VSD patients.
Objectives:
Survival after surgical repair of a ventricular septal defect (VSD) is good, but, as in almost all congenital heart diseases, late complications are frequent in adulthood. The exact mechanisms, timing and who is at risk are not fully understood. Altered cardiac autonomic nervous system (ANS) activity might play a role in these long-term sequelae. The aim of this study was to extensively evaluate children late after VSD repair including their cardiac ANS activity, cardiac function and exercise capacity.
Methods:
Thirty-three patients after surgical VSD repair and 66 healthy age-matched controls underwent 24-h monitoring of ANS control and cardiac output using impedance cardiography, detailed echocardiography and cardiopulmonary exercise testing.
Results:
Ambulatory cardiac ANS control was not different between the patients and the controls. Right ventricular function, exercise capacity and ambulatory cardiac output were decreased in patients compared with the controls. No relationships were found between cardiac ANS activity and cardiac function.
Conclusions:
Long (average time after repair was 9.9 years) after successful surgical correction of a VSD, cardiac ANS control is not different from the controls. Right ventricular function and exercise capacity are impaired in VSD patients. Post-surgical outcome in these patients may be less benign than presently assumed; therefore, follow-up should be continued into adulthood to detect adverse outcomes in a timely fashion.
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