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Updated: Jun 26, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Utility of Follow-Up Surveillance Echocardiograms in Uncomplicated Surgical Closures of Perimembranous Ventricular
Macala Maney1, Carson Richardson2,3, Isaac Kistler2,3
1The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.
Insights
Routine echocardiograms after surgical closure of perimembranous ventricular septal defects (VSD) rarely detect new issues beyond one year. Reassessing the need for long-term surveillance may be beneficial for uncomplicated cases.
Area of Science:
- Cardiology
- Pediatric Surgery
- Congenital Heart Disease
Background:
- Ventricular septal defects (VSD) are the most common congenital heart disease (CHD).
- Current guidelines recommend surveillance transthoracic echocardiograms (TTE) after surgical closure of perimembranous VSDs (pVSD).
- The optimal duration for post-surgical TTE screening remains undefined.
Purpose of the Study:
- To evaluate the clinical utility of follow-up TTEs after uncomplicated surgical closure of pVSD.
- To assess the incidence of complications beyond one year post-repair.
Main Methods:
- Retrospective analysis of 117 patients undergoing pVSD surgical closure.
- Exclusion of patients with other CHD, complications within 1 year, or insufficient data.
- Review of serial TTEs and Kaplan-Meier analysis for 5-year complication-free survival.
Main Results:
- A 97% 5-year complication-free survival rate was observed.
- Only four patients experienced complications more than one year post-repair.
- In 113 complication-free patients, 197 TTEs yielded no changes in clinical management.
Conclusions:
- New complications after uncomplicated pVSD surgical closure are infrequent beyond one year.
- Routine TTEs beyond one year post-repair may not be necessary for uncomplicated cases unless clinical concerns arise.
- Further multicenter studies are warranted to confirm the utility of long-term routine TTE surveillance.
Abstract:
Background: Ventricular septal defects (VSD) are the most common form of congenital heart disease (CHD). Current guidelines recommend surveillance transthoracic echocardiograms (TTE) following surgical closure of perimembranous VSDs (pVSD); however, duration of screening is not explicitly stated. The goal of this study is to determine the utility of follow-up TTEs after uncomplicated pVSD surgical closure. Methods: Single-site retrospective analysis was conducted on patients who underwent pVSD surgical closure. Patients were excluded if diagnosed with other CHD, had complications 1 year post-repair, or lacked data 1 year post-repair. Serial TTEs were reviewed. A Kaplan-Meier curve was used to illustrate the 5-year complication-free survival. Results: A total of 117 patients met inclusion criteria. A 97% 5-year complication-free survival was observed. Four patients had complications >1 year post-repair: one non-obstructive subaortic ridge, one pulmonary vein stenosis, one pinhole residual pVSD, and one ventricular ectopy with ventricular dysfunction. Of the 113 complication-free patients, 197 TTEs were performed with no change in clinical management. Conclusions: Beyond 1 year post-repair, the occurrence of new complications following uncomplicated pVSD surgical closure is rare. Unless clinical concerns arise, the utility of routine TTEs > 1 year post-repair in this uncomplicated post-surgical cohort should be reassessed. Larger multicenter studies are needed to determine the utility of routine TTEs.
