The natural and postoperative history of 252 patients with proved ventricular septal defects

Doppler echocardiographic evaluation of ventricular septal defects in adults

Ventricular septal defects account for 10% to 15% of all congenital heart defects observed in adults. The type of defects observed tend to fall at the extreme ends of the spectrum: small restrictive defects with minimal shunts, and large nonrestrictive defects associated with severe occlusive pulmonary vascular disease. Doppler echocardiography has evolved into a powerful diagnostic modality that comprehensively evaluates the anatomical and pathophysiological consequences of a ventricular septal defect. The spectrum of findings caused by ventricular septal defects is the subject of this review.

Ventricular septal defect in the adult: natural and unnatural history

From 1951 to 1981 we evaluated 79 adult patients with ventricular septal defect with no other associated cardiac malformations. There were 42 men and 37 women ranging in age from 18 to 59 years (mean 34 years). We divided our patients into 67 patients treated medically and 12 surgically. Follow-up was obtained on 78 of 79 patients (99%). All patients were followed up for 1 month to 25 years (mean 9 years). Their ages at follow-up ranged from 24 to 70 years (mean 42 years). Nonsurgically treated patients who were New York Heart Association functional class I before treatment had a significantly better survival rate than had those who were functional class II to IV (p less than 0.001). Nonsurgically treated patients with cardiomegaly had a significantly poorer survival experience than had those without pretreatment cardiomegaly (p less than 0.001). Medical patients also had significantly poorer survival rates if the mean pulmonary artery systolic pressure was greater than 50 mm Hg (p less than 0.001). The 10-year survival rate for all patients was 76%. In general, adult patients with ventricular septal defect treated medically remained clinically stable over a long follow-up period, but survival was significantly influenced by pretreatment functional class, pulmonary artery systolic pressure, and cardiomegaly.

Congenital heart disease and childhood adjustment

This report deals with the findings from a study of twenty-eight children, all of whom had ventricular septal defects and were studied by the same cardiovascular team. One-half of the group had a surgical procedure for correction of the defect.

The study investigated three problems in children with ventricular septal defect ( VSD). (1) Do children with surgical intervention for VSD show greater impairment of intellectual functioning than non-operated children? (2) Do children with surgical intervention show greater emotional disturbance than non-operated children? (3) Do children with surgical intervention show greater alteration of body image than do non-operated children?

Data were collected using questionnaires, family interviews, subject interviews, medical records, school reports, physicians' reports and Human Figure Drawings, both inside and outside the body.

The findings conclude that ( a) operated children do demonstrate significantly more impairment of intellectual functioning; ( b) there was no significant difference in the incidence of emotional disturbances between the two groups but that these twenty-eight children with VSD were more similar emotionally to children in a psychiatric clinic group than in a control group; and ( c) the only indication of altered body image was found in the greater frequency with which bones were drawn by the operated group.