Small ventricular septal defects in adults

Aims To establish the frequency of complications in adults with small ventricular septal defects, which have not undergone surgery. Methods and Results One hundred and eighty-eight adults aged 17-72 (mean, 29.2) years with a small ventricular septal defect were studied. They were referred to a national cardiac centre (National Heart Hospital) and specialized grown-up congenital heart unit. One hundred and thirty-eight were examined in 1994-95. Fifty patients (26.6%) had additional cardiovascular lesions, most commonly a bicuspid aortic valve and/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 in 37 (19.7%) patients; it was severe in nine. Atrial arrhythmias (supraventricular tachycardia or atrial fibrillation) occurred in 12 patients. In four patients, atrial fibrillation produced severe right-sided congestion with a left ventricular to right atrial shunt and haemodynamic features suggesting restrictive cardiomyopathy'. Four patients had ventricular arrhythmia. Disproportionate left ventricular enlargement on echocardiography and/or chest radiography was present in 26 (13.8%) without lesions 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 complications: infective endocarditis (11%), progressive aortic regurgitation (5%), age-related symptomatic arrhythmias (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 necessarily benign during adult life.