Isolated ventricular septal defect in adults. Clinical and haemodynamic findings

Clinical and haemodynamic findings were reviewed in 109 consecutive patients in whom an isolated ventricular septal defect was diagnosed after the age of 15 years (range 15-65 years). Most patients had no or minor cardiac symptoms. Based on the left to right shunt size and pulmonary pressure, 32 (29%) patients had large and 75 (69%) small ventricular septal defects, whereas in two (2%) patients data were insufficiently complete for determining the size. The anatomical location was membranous in 92% and muscular in 8% of the 51 patients in whom this could be assessed from a left ventricular angiogram or the surgeon's report of a subsequent operation, or both. Nine (8%) patients had developed the Eisenmenger syndrome, 12 had aortic regurgitation, and 16 (15%) had bacterial endocarditis, the incidence of the latter being 5.7 per 1000 patient years. Of the 34 (31%) patients who underwent surgery, five (15%) died while in hospital. In contrast with reports from paediatric series our study in adults showed a predominance of small ventricular septal defects and a high frequency of irreversible pulmonary hypertension and serious complications, such as aortic regurgitation and bacterial endocarditis. Thus ventricular septal defects in adults should--regardless of symptoms--be looked on as potentially serious.