Ventricular septal defect with secondary left ventricular-to-right atrial shunt is associated with a higher risk for infective endocarditis and a lower late chance of closure.
OBJECTIVE
Although ventricular septal aneurysm may diminish or even close the shunt through the ventricular septal defect (VSD), developing a left ventricular-to-right atrial (LV-RA) shunt may be unfavorable. This study sought to clarify this issue on the basis of an extended observation of such patients.


METHODS
Sixty-eight patients (1201 patient-years) who had small perimembranous VSD and LV-RA shunt and were not operated on before 6 years of age were studied.


RESULTS
The onset age of LV-RA shunt was 5.8 +/- 3.3 years, with clinical improvement later observed in 23 (34%). The murmur disappeared and showed spontaneous closure in 5 (7%). Seven episodes of infective endocarditis occurred in 6 (8.7%, or 58 per 10000 patient-years), with 2 receiving surgery. Another 4 received surgery during follow-up. With echocardiography, aneurysmal transformation involving the anterior and septal leaflets of tricuspid valve (double sac) was found in 56 (85%), whereas only the septal leaflet (single sac) was involved in 10. Patients with double sac were less likely to show improvement, whereas patients who had superior QRS axis and were female showed clinical improvement more frequently.


CONCLUSIONS
VSD with secondary LV-RA shunt is associated with a higher risk for infective endocarditis but still has a low chance for late improvement and even closure.
Wu
Mei-Hwan
MH
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan. mhwu@ha.mc.ntu.edu.tw
Wang
Jou-Kou
JK
Lin
Ming-Tai
MT
Wu
En-Ting
ET
Lu
Frank Leigh
FL
Chiu
Sheunn-Nan
SN
Lue
Hung-Chi
HC
D000293:Adolescent; D000328:Adult; D002648:Child; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000209:etiology*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D012307:Risk Factors; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000473:pathology