Long-Term Outcome of Patients with Perimembranous Ventricular Septal Defect: Results from the Belgian Registry on Adult Congenital Heart Disease

Abstract

Objectives: Studies evaluating the long-term outcome of adults with ventricular septal defect (VSD) are important to inform patients about prognosis. This study investigated the long-term outcome of patients with perimembranous VSD (pmVSD) followed in the Belgian Registry on Adult Congenital Heart Disease. Methods: All pmVSD patients in the registry were analyzed. Results: Two hundred and sixty-six patients were studied. Fifteen patients had Eisenmenger syndrome. One hundred and seventy-three had isolated pmVSD and 78 had pmVSD with concomitant lesions. Of the patients with isolated pmVSD, 52% were male, median age was 29 years (IQR 24-35 years) and median follow-up duration was 18 years (IQR 10-25 years). Fifty-three (31%) patients underwent VSD closure and 10 (19%) had a residual shunt. Most (93%) patients were in NYHA class I. No patients died. Two (4%) patients developed atrial arrhythmia and 2 (4%) required pacemaker implantation. Seven (14%) developed left ventricular outflow tract obstruction (LVOTO). In the unrepaired pmVSD group, 4 developed endocarditis. In the entire group, moderate or severe aortic regurgitation (AR) occurred in 9 (5%) patients. Conclusions: Long-term survival in patients with isolated pmVSD was not uneventful. Moderate or severe AR might develop and endocarditis occurred in patients without VSD repair. Complications after VSD closure included atrial arrhythmia, pacemaker implantation and LVOTO.

Long-Term Follow-Up after Perimembranous Ventricular Septal Defect Repair

“…The differences in the rates of spontaneous closure may be related to the different length of follow-up (29 vs. 7 years) but the overall results mirrored those of Gabriels et al [5]. …”

“…In the study by Gabriels et al [5], the long-term outcomes of patients with perimembranous VSD (pmVSD), followed by the Belgian Registry on Adult Congenital Heart Disease, were analyzed. Median age at last visit was 29 years and median follow-up time was 18 years.…”

“…Pulmonary hypertension developed infrequently in repaired and unrepaired pmVSDs. The most common long-term complications were the development of LVOT obstruction and significant AI, the latter occurring more frequently in patients with predisposing LVOT malformations [5]. …”

“…The major limitations of the study by Gabriels et al [5] are the selection bias and immortal time bias, as discussed by the authors. Selection bias may have occurred in that patients who had small VSDs several decades ago may have been lost to follow-up, thus selecting for larger VSDs in the registry.…”

Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival

“…Because of prior surgical procedures, individuals with CHD are at increased risks of cardiac arrhythmia and developing ventricular dysfunction [32][33][34] . The risk of adverse cardiovascular outcomes after childbirth in women with CHD has not been well studied.…”