Small ventricular septal defects in adults

Aims To establish the frequency of complications in adults withsmall ventricular septal defects, which have not undergone surgery. Methods and Results One hundred and eighty-eight adults aged17–72 (mean, 29·2) years with a small ventricularseptal defect were studied. They were referred to a nationalcardiac centre (National Heart Hospital) and specialized grown-upcongenital heart unit. One hundred and thirty-eight were examinedin 1994–95. Fifty patients (26·6%) had additionalcardiovascular lesions, most commonly a bicuspid aortic valveand/or coarctation. Spontaneous closure occurred in 19 (10%)between the age of 17 and 45 (mean, 27) years. Twenty-one (11·2%)had infective endocarditis. Aortic regurgitation developed in37 (19·7%) patients; it was severe in nine. Atrial arrhythmias(supraventricular tachycardia or atrial fibrillation) occurredin 12 patients. In four patients, atrial fibrillation producedsevere right-sided congestion with a left ventricular to rightatrial shunt and haemodynamic features suggesting ‘restrictivecardiomyopathy’. Four patients had ventricular arrhythmia.Disproportionate left ventricular enlargement on echocardiographyand/or chest radiography was present in 26 (13·8%) withoutlesions to account for it. Conclusions Eighty nine patients (47%) aged 17–44 (mean,26·8) years had no complications through many years,while spontaneous closure occurred in 19 (10%) during adulthood.Forty-six (25%) had serious compli-cations: infective endocarditis(11%), progressive aortic regurgitation (5%), age-related symptomaticarrhythmias (8·5%) and atrial fibrillation the commonest.Accepting that there may be a referral bias for those with complications,the course of a small ventricular septal defect is not necessarilybenign during adult life.