Long-Term Outcome of Transcatheter Device Closure of Perimembranous Ventricular Septal Defects

Ventricular septal defect

ESC CardioMed ◽

10.1093/med/9780198784906.003.0186 ◽

2018 ◽

pp. 799-801

Author(s):

Orla Franklin

Keyword(s):

Ventricular Septal Defect ◽

Congenital Malformation ◽

Septal Defect ◽

Ventricular Septal Defects ◽

Term Outcome ◽

Long Term Outcome ◽

Septal Defects

Ventricular septal defect is the commonest congenital malformation and many are small and close spontaneously. Significant ventricular septal defects require closure in infancy. Long-term outcome is excellent.

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Intermediate and Long-Term Outcome of Percutaneous Trans-catheter Device Closure of Ventricular Septal Defects

QJM ◽

10.1093/qjmed/hcab090.005 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Maiy Hamdy El Sayed ◽

Hebatallah Mohammed Attia ◽

Tarek Khairy Mousa ◽

Ahmed Amr El Alfy

Keyword(s):

Valvular Regurgitation ◽

Ventricular Septal Defects ◽

Device Closure ◽

Long Term Outcome ◽

Septal Defects ◽

Catheter Occlusion ◽

Tertiary Center ◽

Occlusion Technique

Abstract Background Ventricular septal defect (VSD) is the most common congenital heart defect in children and adults. Until recently, open-heart surgical closure has traditionally been considered the mainstay of intervention for the majority of VSDs. The development of a trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices that can safely and effectively close these defects was welcomed by cardiologists, patients, and their families making trans-catheter device closure an attractive and feasible alternative. Objective We aim to evaluate the intermediate and long-term follow-up outcome of patients who underwent percutaneous trans-catheter closure of isolated ventricular septal defects. Patients and Methods This study is an exploratory pilot single-tertiary center study. The study included 25 patients who have successfully undergone percutaneous ventricular septal closure in the cardiac catheterization unit of the cardiology department at Ain Shams university Hospitals in the period from June 2015 till June 2018. The follow up protocol includes detailed history taking, clinical examination, and full 2D echocardiography with additional circumferential and radial strain imaging by speckle tracking technique (STE), resting and Holter electrocardiograms. Results A significant increase in growth parameters were noticed during 6.3 month mean follow up time, with an overall mean weight increase by 10% and an overall mean height increase by 6.2%. Sequential echocardiographic follow-up showed highly significant decrease in LV dimensions and volumes, circumferential LV strain values, pulmonary to systemic circulation (Qp:Qs) ratio, RVSP and mPAP. Significant complications occurred in (12%) of patients: symptomatic/significant Brady-arrhythmia (Complete heart block) that required permanent pacemaker implantation (4%), significant residual shunt causing hemolytic anemia requiring re-intervention (4%) and significant valvular regurgitation (Severe Tricuspid Regurgitation) (4%) Conclusion The development of a VSD trans-catheter occlusion technique with the advancement of the newer percutaneous occluding VSD closure devices is an attractive and feasible procedure with high success rates

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Reduced biventricular contractility during exercise in adults with small, unrepaired ventricular septal defects: an echocardiographic study

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz278 ◽

2019 ◽

Author(s):

Marie Maagaard ◽

Johan Heiberg ◽

Andrew N Redington ◽

Vibeke E Hjortdal

Keyword(s):

Right Ventricular ◽

Functional Capacity ◽

Left Ventricular ◽

Ventricular Septal Defects ◽

Term Outcome ◽

Long Term Outcome ◽

Septal Defects ◽

Echocardiographic Study ◽

Underlying Mechanisms

Abstract OBJECTIVES Small ventricular septal defects are often considered to be without long-term haemodynamic consequences and so the majority remains unrepaired. However, we recently showed reduced functional capacity and altered right ventricular morphology in adults with small, unrepaired ventricular septal defects. The underlying mechanisms behind these findings remain unclear, and so, biventricular contractility during exercise was evaluated. METHODS Adults with small, unrepaired ventricular septal defects and healthy controls were examined with echocardiography during supine bicycle exercise with increasing workload. Tissue velocity Doppler was used for evaluating isovolumetric acceleration and systolic velocities during exercise. RESULTS In total, 34 patients with ventricular septal defects, a median shunt- ratio of 1.2 (26 ± 6 years), and 28 healthy peers (27 ± 5 years) were included. Right ventricular isovolumetric acceleration was lower in patients as compared with controls at rest (97 ± 40 vs 158 ± 43 cm/s2, P = 0.01) and at peak heart rate (222 ± 115 vs 410 ± 120 cm/s2, P < 0.01). Peak systolic velocities were similar at rest, but differed with exercise (13 ± 3 vs 16 ± 3 cm/s, P = 0.02). Left ventricular isovolumetric acceleration was lower in patients as compared with controls throughout the test (P < 0.01). Septal isovolumetric acceleration was similar at rest, but reduced during increasing exercise as compared with controls (220 ± 108 vs 303 ± 119 cm/s2, P = 0.03). Left ventricular isovolumetric acceleration was negatively correlated with the shunt- ratio, and right ventricular and septal peak systolic velocities were positively correlated with lower functional capacity. CONCLUSIONS Altered biventricular contractility is present during exercise in adults with small, unrepaired ventricular septal defects. These results add to the growing number of studies showing that long-term outcome in unrepaired ventricular septal defects may not be benign.

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Cardiac Arrhythmias and Impaired Heart Rate Variability in Older Patients With Ventricular Septal Defects

Journal of the American Heart Association ◽

10.1161/jaha.120.020672 ◽

2021 ◽

Author(s):

Marie Maagaard ◽

Filip Eckerström ◽

Vibeke E. Hjortdal

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Ventricular Septal Defects ◽

Cardiac Events ◽

Term Outcome ◽

Premature Ventricular Contractions ◽

Long Term Outcome ◽

Septal Defects ◽

Normal Ranges

Background Congenital ventricular septal defects (VSDs) are considered to have benign long‐term outcome when treated correctly in childhood. However, abnormal parameters are described in younger adults, including impaired heart rate variability (HRV). It is not known whether such abnormalities will deteriorate with age. Therefore, HRV and cardiac events, such as premature ventricular contraction, were evaluated in patients aged >40 years with congenital VSDs and compared with healthy peers. Methods and Results A total of 30 surgically closed VSDs (51±8 years, repair at median age 6.3 years with total range 1.4–54 years) with 30 healthy controls (52±9 years) and 30 small, unrepaired VSDs (55±12 years) with 30 controls (55±10 years) were all equipped with a Holter monitor for 24 hours. Compared with healthy peers, surgically closed patients had lower SD of the normal‐to‐normal (NN) interbeat interval (129±37 versus 168±38 ms; P <0.01), SD of the average NN intervals for each 5‐minute segment of a 24‐hour HRV recording (116±35 versus 149±35 ms; P <0.01) and 24‐hour triangular index (31±9 versus 44±11; P <0.01). SD of the NN intervals, SD of the average NN intervals for each 5‐minute segment of a 24‐hour HRV recording, and triangular index were comparable between unrepaired VSDs and healthy peers. SD of the NN intervals was <100 ms in 22% of surgically closed and 10% of unrepaired VSDs, whereas controls were within normal ranges. A high number of premature ventricular contractions (>200 events) was registered in 57% of surgical patients compared with 3% of controls ( P <0.01), and 53% of unrepaired VSDs compared with 10% in controls ( P <0.01). Conclusions Adults aged >40 with congenital VSDs demonstrate impaired HRV, mainly among surgically closed VSDs. More than half demonstrated a high number of premature ventricular contractions. These novel findings could indicate long‐term cardiovascular disturbances. This necessitates continuous follow‐up of VSDs throughout adulthood.

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