Small ventricular septal defects in adults

Eur Heart J. 1998 Oct;19(10):1573-82. doi: 10.1053/euhj.1998.1083.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aortic Valve Insufficiency / etiology
  • Aortic Valve Stenosis / etiology
  • Arrhythmias, Cardiac / etiology
  • Cardiomyopathy, Dilated / etiology
  • Electrocardiography
  • Endocarditis, Bacterial / etiology
  • Female
  • Follow-Up Studies
  • Heart Septal Defects, Ventricular* / complications
  • Heart Septal Defects, Ventricular* / diagnostic imaging
  • Heart Septal Defects, Ventricular* / mortality
  • Humans
  • Male
  • Middle Aged
  • Remission, Spontaneous
  • Retrospective Studies
  • Ultrasonography
  • Ventricular Dysfunction, Left / etiology