乌鸦传媒

Repairing ventricular septal defects (VSDs) in childhood did not always prevent impairments in functional capacity decades later, researchers from one center reported.

Adults over age 40 had differences in exercise capacity on cardiopulmonary exercise testing according to their ventricular septal defect (VSD) status:

• Peak oxygen uptake was 29% lower in participants with surgically-closed VSDs and 21% lower in those with unrepaired VSDs, compared with healthy controls (both P<0.01).
• Oxygen uptake was 35% lower in people with closed VSDs and 21% lower in the case of small unrepaired VSDs, compared with controls (both P<0.01).
• At exercise levels as low as 20% of maximal workload, patients with surgically-closed VSDs (4.2 vs 6.2 mL/min per kg) and those with small unrepaired VSDs (4.6 vs 6.1 mL/min per kg) had lower oxygen uptake compared with controls (both P<0.01).
• Peak ventilation was reduced in patients with surgically-closed VSDs than control participants (1.0 vs 1.4 L/min per kg, P<0.01) but similar between patients with unrepaired VSDs and their respective controls (P=0.14).

Comparing these deficits in older VSD patients with previous reports of younger cohorts, "their exercise capacity does not seem to normalize but rather deteriorates further with increasing age," according to a team led by Marie Maagaard MD, PhD, of Aarhus University Hospital, Denmark.

Their report was published online in the . Results were previously presented as a poster at the American Heart Association (AHA) conference in 2019.

"This study clearly emphasizes that living with a congenital VSD, surgically closed or unrepaired, is not a static state with outcomes comparable to those of healthy peers," investigators said. "Our novel findings warrant attention for aging patients with congenital VSDs and suggest continuous follow-up in specialized cardiology clinics."

Such routine follow-up of these simple defects had generally not been recommended until the called for routine follow-up visits (including exercise testing) for people with repaired or surgically-closed VSD.

This year, heart societies released the first appropriate use criteria for follow-up imaging in people with congenital heart disease.

The study included 30 people over age 40 (average 51) with surgically-closed VSDs who were matched to healthy controls recruited in 2018-2019 (n=30; 52 years). A separate cohort of 30 adults with small, unrepaired VSDs (average age 55) were matched to controls from the contemporary period (n=30; 55 years).

Among those with surgically-closed VSDs, over half of patients were discharged after VSD repair before turning 10 years old. All except for one had undergone the surgery at Maagaard's institution in 1967-2015.

Limitations of the study included the lack of contemporary catheterization data, the small sample, and a cross-sectional (instead of longitudinal) analysis comparing younger versus older VSD patients, study authors acknowledged.

"Nevertheless, these findings could form the basis of multicenter studies with larger numbers of patients or longitudinal studies investigating long-term outcomes in terms of hemodynamics in the isolated VSD," they wrote.

Comment