Small ventricular septal defects in adults.
OBJECTIVE
To establish the frequency of complications in adults with small ventricular septal defects, which have not undergone surgery.


RESULTS
One hundred and eighty-eight adults aged 17-72 (mean, 29.2) years with a small ventricular septal defect were studied. They were referred to a national cardiac centre (National Heart Hospital) and specialized grown-up congenital heart unit. One hundred and thirty-eight were examined in 1994-95. Fifty patients (26.6%) had additional cardiovascular lesions, most commonly a bicuspid aortic valve and/or coarctation. Spontaneous closure occurred in 19 (10%) between the age of 17 and 45 (mean, 27) years. Twenty-one (11.2%) had infective endocarditis. Aortic regurgitation developed in 37 (19.7%) patients; it was severe in nine. Atrial arrhythmias (supraventricular tachycardia or atrial fibrillation) occurred in 12 patients. In four patients, atrial fibrillation produced severe right-sided congestion with a left ventricular to right atrial shunt and haemodynamic features suggesting 'restrictive cardiomyopathy'. Four patients had ventricular arrhythmia. Disproportionate left ventricular enlargement on echocardiography and/or chest radiography was present in 26 (13.8%) without lesions to account for it.


CONCLUSIONS
Eighty nine patients (47%) aged 17-44 (mean, 26.8) years had no complications through many years, while spontaneous closure occurred in 19 (10%) during adulthood. Forty-six (25%) had serious complications: infective endocarditis (11%), progressive aortic regurgitation (5%), age-related symptomatic arrhythmias (8.5%) and atrial fibrillation the commonest. Accepting that there may be a referral bias for those with complications, the course of a small ventricular septal defect is not necessarily benign during adult life.
Neumayer
U
U
Jane Somerville Grown-Up Congenital Heart Unit, Royal Brompton Hospital, London, U.K.
Stone
S
S
Somerville
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000209:etiology; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002311:Cardiomyopathy, Dilated / Q000209:etiology; D004562:Electrocardiography; D004697:Endocarditis, Bacterial / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000209:etiology