Background-Aortic valve stenosis (with or without aortic regurgitation and without associated mitral stenosis) in adults in the Western world has been considered in recent years to most commonly be the result of degenerative or atherosclerotic disease. Methods and Results-We examined operatively excised, stenotic aortic valves from 932 patients aged 26 to 91 years (meanϮSD, 70Ϯ12), and none had associated mitral valve replacement or evidence of mitral stenosis: A total of 504 (54%) had congenitally malformed valves (unicuspid in 46 [unicommissural in 42; acommissural in 4] and bicuspid in 458); 417 (45%) had tricuspid valves (either absent or minimal commissural fusion); and 11 (1%) had valves of undetermined type. It is likely that the latter 11 valves also had been congenitally malformed. Of the 584 men, 343 (59%) had either a unicuspid or a bicuspid valve; of the 348 women, 161 (46%) had either a unicuspid or a bicuspid aortic valve. Conclusions-The data from this large study of adults having isolated aortic valve replacement for aortic stenosis (with or without associated aortic regurgitation) and without associated mitral stenosis or mitral valve replacement strongly suggest that an underlying congenitally malformed valve, at least in men, is more common than a tricuspid aortic valve.

Background Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. Objectives This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Methods Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. Results From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. Conclusions COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.

516Ventricular septal defect (VSD) is the most common congenital heart malformation and can be detected during the prenatal and postnatal period, in childhood, and in adulthood. Spontaneous closure of VSD can be determined through a variety of methods-echocardiography, Doppler color flow imaging, angiography, auscultation, and cardiac catheterization-and can be proven by pathological evidence at necropsy. There are two major types of VSD, membranous and muscular, as well as the perimembranous variety, which comprises variable portions of the adjacent muscular septum but lacks the membranous septum. VSD appears either as an isolated cardiac defect without other abnormalities or with several complex malformations. It has long been recognized that VSD can close spontaneously, but the incidence of spontaneous VSD closure is still uncertain. Since necropsy study of the hearts with VSD has rarely been reported, information on morphological features of spontaneous VSD closure remains limited. In addition, the mechanisms for spontaneous VSD closure are not fully understood. Herein, we present a brief review of the incidence of spontaneous VSD closure, morphological characteristics of the closure, and the main mechanisms responsible for the closure. INCIDENCE OF SPONTANEOUS VSD CLOSURETh e incidence of spontaneous ventricular septal defect (VSD) closure varies greatly, depending on the age and gender of subjects at spontaneous closure, the size and site of the defect, the types of defect, as well as the population studied, methods employed, and length of follow-up period. Table 1 presents available data on the incidence of spontaneous VSD closure.Age and gender. Age has been found to have a significant infl uence on the incidence of spontaneous VSD closure, whereas gender seems less likely to aff ect the incidence. Although spontaneous VSD closure can occur at any agegestation, infancy, childhood, adolescence, and adulthood (1)-it occurs most commonly during the fi rst 6 months of life (2), during the fi rst year (3, 4), or soon after the fi rst year of life (5). Afterward, the occurrence of closure declines progressively and occurs less commonly after the age of 10 (5). It has been documented that the incidence of the close increases with age, from 24% at 18 months of age to 50% at 48 months and 75% at 120 months (6). However, in older children, at 3.5 years old, the incidence declines sharply to 44% and then rises to 66% at 7 years and 75% at 10.5 years (6). A similar trend has been found in other reports, which showed 57% (109/190) of cases closed before 3 years of age, 89% (169/190) closed before 8 years of age (7), and 4% to 10% closed after the age of 17 (8, 9). During adulthood, the incidence of spontaneous VSD closure remarkably declines. One study showed that of 188 adults with VSD, 19 patients' (10%) VSD closed spontaneously between the age of 17 and 45 years, and the incidence of closure was greater in the 17-to 24-year age group than the 25-to 34-year group, the 35-to 44-year group, and the ≥45-year group (8)...

No abstract