Bidirectional flow in congenital ventricular septal defect: a Doppler echocardiographic study

The midterm effect of exercise capacity and quality of life in adult patients who underwent hybrid transthoracic device closure of ventricular septal defects

OBJECTIVE

To investigate the midterm effect of exercise capacity and quality of life (QoL) of adult patients who underwent transthoracic device closure of ventricular septal defects (VSDs) and explore the gap in the quality of life and cardiopulmonary function between those patients and healthy people.

METHODS

From January 2010 to January 2015, 58 adult patients who underwent transthoracic device closure of VSD and 60 healthy people matched for age and sex were selected and analyzed. Echocardiography and exercise capacity tests were performed, and the MOS 36-item short-form health survey (SF-36) was used to investigate the changes in QoL.

RESULTS

Fifty-five patients completed the study. At the 1-year and 5-year follow-ups, the patients' left ventricular end-systolic and end-diastolic diameters were smaller than those preoperatively, but the difference was not statistically significant. In the QoL survey, the patients' scores after treatment showed a trend of improvement, and the improvement effect was not transient. After VSD closure, the difference in QoL between the patients and the control group was significantly reduced. However, in the exercise capacity test, the patients' results were still worse than those of the controls.

CONCLUSION

Transthoracic device closure of VSDs is significant in improving adult patients' QoL at the midterm follow-up, reflected in their physical and psychological fields. However, they are still unable to achieve normal levels of peak exercise ability. Therefore, further exploration and interventions are worth considering.

Effect of size of ventricular septal defect and age on pulmonary hemodynamics at sea level

In 1,265 patients with isolated ventricular septal defects (Natural History Study of congenital heart defects, 1977), older children and adults were classified into those with and without pulmonary hypertension. To ascertain why relatively distinct pulmonary hypertensive and normotensive groups consisted of older children and adults, we reexamined the sea level cardiac catheterization data of 829 patients according to defect size (using the Gorlin formula) and patient age. In patients < 2 years of age, the average pulmonary vascular resistance was not significantly elevated and was not dependent on defect size. Pulmonary hypertension was due to increased blood flow, except for the 2.7% of patients with Eisenmenger-like physiology. For those > 2 years of age, both pulmonary arterial pressure and resistance were higher (p < 0.05) in patients with defect sizes of > 0.5 cm2/m2 than in those with smaller defects, and the Eisenmenger-like physiology was more common in older patients (17.4% in patients aged > 10 years). The group with distinctly higher pressure after 4 years of age reflected higher pulmonary vascular resistances in those in whom large defects persisted. However, 84% of patients aged > 4 years who underwent cardiac catheterization had smaller defects (< 0.5 cm2/m2), accounting for the group observed with low pressure.