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Long-term outcome of patients with ventricular septal defect considered not to require surgical closure during childhood


, : Long-term outcome of patients with ventricular septal defect considered not to require surgical closure during childhood. Journal of the American College of Cardiology 39(6): 1066-1071, March 20

OBJECTIVES The purpose of the study was to assess the long-term outcome of patients with small ventricular septal defects (VSDs) considered not to require surgical closure during childhood. BACKGROUND Although patients with small VSDs have generally been considered not to require surgery, more recent data suggest that a significant percentage of these patients develop serious problems during adult life. METHODS A total of 229 consecutive patients (115 females) with a VSD considered too small to require surgery during childhood as defined by normal pulmonary artery pressure, less than 50% shunt, pulmonary vascular resistance ltoreq200 dynescntdotscntdotcm-5, no VSD-related aortic regurgitation (AR), and no symptoms and who had no additional hemodynamically relevant heart defect were followed in an adult congenital heart disease program. Physical examination, electrocardiography, and echocardiography were performed in all patients in one- to three-year intervals; exercise tests and Holter monitoring were performed in 140 and 127 patients, respectively. RESULTS Follow-up was completed in 222 patients (97%). Mean age at last visit was 30 +- 10 years. Spontaneous VSD closure was observed in 14 patients (6%). No patients died, four patients (1.8%) had an episode of endocarditis, of whom two required aortic valve replacement, and one additional patient (0.4%) had surgical closure for hemodynamic reasons. For 118 patients who entered the study between 1993 and 1996 and were prospectively followed for 7.4 +- 1.2 years, event-free survival with end points defined as death, endocarditis or heart surgery was 99.1 +- 0.8% at three years, 96.5 +- 1.7% at six years and 95.5 +- 1.9% at eight years. At last visit, 94.6% of all patients studied were symptom free. Left ventricular (LV) size by echocardiography was normal in 198 (89%) patients, borderline in 23 patients and definitely enlarged in only one patient. None had systolic LV dysfunction, and pulmonary artery pressure (PAP) was normal in all patients. Mean exercise capacity was 92 +- 21% of expected, and 87% of patients had no arrhythmias on Holter monitoring, with the remainder showing benign rhythm disorders. CONCLUSIONS Outcome in well-selected patients with a small VSD is good. Surgical closure does not appear to be required during childhood as long as left-to-right shunt is <50% and signs of LV volume overload are absent, when PAP is not elevated, and no VSD-related AR or symptoms are present.

US$19.90

PMID: 11897452

DOI: 10.1016/s1062-1458(02)00841-3


Other references

Kato, M.; Shiode, N.; Yamagata, T.; Matsuura, H.; Kajiyama, G., 1997: Coronary segmental responses to acetylcholine and bradykinin in patients with atherosclerotic risk factors. This study was designed to elucidate the nature of coronary endothelial dysfunction in patients with hypertension and/or hypercholesterolemia and normal smooth coronary arteries by evaluating the coronary vascular responses to acetylcholine and br...

Vassiliades, T., 2010: Enabling technology for minimally invasive coronary artery bypass grafting. Over the past 8 years, new techniques and perhaps more significantly new technology have expanded the possibilities for minimally invasive coronary artery bypass grafting. In this section, we review 3 important and potentially enabling technologie...

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Rauck, A.; Mccart, L.; Martinez, L.; Qualman, S., 1993: A nude rat model of human neuroblastoma using orthotopic implantation. Proceedings of the American Association for Cancer Research Annual Meeting 34(0): 59

Krach, Sören.; Kamp-Becker, I.; Einhäuser, W.; Sommer, J.; Frässle, S.; Jansen, A.; Rademacher, L.; Müller-Pinzler, L.; Gazzola, V.; Paulus, F.M., 2016: Evidence from pupillometry and fMRI indicates reduced neural response during vicarious social pain but not physical pain in autism. Autism spectrum disorder (ASD) is characterized by substantial social deficits. The notion that dysfunctions in neural circuits involved in sharing another's affect explain these deficits is appealing, but has received only modest experimenta...

Ashraf Poswal M.; Berberet R.C.; Young L.J., 1990: Time specific life tables for acyrthosiphon kondoi homoptera aphididae in first crop alfalfa in oklahoma usa. Time-specific life tables were developed for Acyrthosiphon kondoi Shinji in Oklahoma during growth of the first alfalfa crop in 1985 and 1986. In each year, population densities increased rapidly (from < 10 to > 200 aphids per stem) during a...

Takayasu, M., 2009: Less invasive surgery for cervical spine. One of the currently most important subjects in the field of surgical treatment is the development of less invasiveness techniques, which includes those involving small openings with minimal skin incision, less pain, better preservation of functio...

Hansen, L.-Bach; Christrup, L.-Louring; Bundgaard, H., 1992: Saliva-catalyzed hydrolysis of a ketobemidone ester prodrug: Factors influencing human salivary esterase activity. Saliva enzyme-catalysed hydrolysis of ester prodrugs or drugs containing sensitive ester groups may be a limiting factor for the buccal absorption of such compounds. Using the isopropyl carbonate ester of ketobemidone as a model substance of a hyd...

van de Linde, P.; Tysma, O.M.H.; Medema, J.P.; Hale, G.; Waldmann, H.; Roelen, D.L.; Roep, B.O., 2006: Mechanisms of antibody immunotherapy on clonal islet reactive T cells. Clinical intervention trials evaluating the efficacy of antibody immunotherapy in type 1 diabetes are in progress. We tested effects on prediabetic islet antigen-specific autoreactive T cells of antithymocyte globulin (ATG) and humanized monoclona...

Wang, E.; Ballister, E.R.; Lampson, M.A., 2011: Aurora B dynamics at centromeres create a diffusion-based phosphorylation gradient. Aurora B kinase is essential for successful cell division and regulates spindle assembly and kinetochore–microtubule interactions. The kinase localizes to the inner centromere until anaphase, but many of its substrates have distinct localiza...