Ventricular septal defect: Survival in adult life

Abstract

The clinical course of thirty-five patients, seventeen years of age and over, with ventricular septal defect observed during the past thirty years is reviewed. Thirty-one patients were studied by right heart catheterization since 1946; ten were recatheterized five to thirteen years after the initial investigation. The remaining four were examined at necropsy before cardiac catheterization technics were available. A wide spectrum of hemodynamic findings was noted at all ages in adult life. The two largest groups were those with normal pulmonary artery pressure (group i) and those with pulmonary artery pressure at approximately the systemic level (group iv). In the first group the patients were essentially asymptomatic and showed no change in pulmonary artery pressure with advancing age. In contrast, most of the patients with severe pulmonary hypertension were symptomatic in infancy or early childhood and probably always had elevated pulmonary artery pressure. They manifested progressive pulmonary vascular disease with the development of cyanosis and ultimately right-sided heart failure. Bacterial endocarditis was the cause of death in three of the four patients examined at necropsy before 1946. This complication was infrequent among the patients in recent years and was never a terminal event. In this series only five patients were forty years of age or over, the oldest was forty-nine years of age. The explanation for lack of patients beyond fifty years is not clear, but shortened survival time is suggested.