Late results (30 to 35 years) after operative closure of isolated ventricular septal defect from 1954 to 1960

This study was designed to determine the clinical status, cause of death, and effects of pulmonary vascular disease and conduction abnormalities 30 to 35 years after surgery in 296 consecutive surviving patients of closure of ventricular septal defect. Of the 296 patients, current status was determined by contact with patient and physician in 290 cases, with 6 (2%) lost to follow-up (7,912 patient years are included). Cardiac catheterization after surgery in 168 patients showed complete closure of the defect in 80%. Death occurred in 59 patients (20%), with higher mortality rates in those operated on after the age of 5 years, those with pulmonary vascular resistance >7 units (51%), and those with complete heart block (78%). Of 37 patients with transient heart block after surgery, 8 (22%) have died (3 pulmonary vascular disease, 2 sudden death, 2 unknown causes and 1 complete heart block). Twenty other patients had a dysrrhythmia after surgery, and none of these died. Nine episodes of endocarditis occurred (11.4/10,000 patient years). Nine of 296 (3%) offspring had cardiac malformation. Most patients are in New York Heart Association class 1, 57% attended college and 15% received an advanced degree. The data show good results for this group of patients operated on during an early era (1954 to 1960) of open cardiac surgery. They support the current trend toward operation in patients with ventricular septal defects at an early age and with low pulmonary vascular resistance.
The adult heart is divided into a left and right half. During embryonic development, however, the division has not yet occurred, and blood can exchange freely between the two halves. If the sequence of embryonic events is disrupted, the septum (wall) which separates the left and right sides of the heart may not develop completely. This condition, called ventricular septal defect, permits the mixing of blood between the two sides of the heart, and results in a very inefficient circulatory system. The first surgical procedure to correct a ventricular septal defect was performed in 1954 at the University of Minnesota. During the next six years, the operation was performed on 341 patients at that institution. Researchers from the University of Minnesota conducted a survey to determine the fate of the 296 patients who survived surgery now that 30 to 35 years have passed since their operations. Six patients were lost to follow-up. Fifty-nine patients have died; the death rate was higher for those who were older than five years at the time of their initial surgery. Six of the dead patients died accidentally, including an unfortunate trampoline accident. Four patients died of infection and one died of congestive heart failure resulting from persisting heart abnormalities. In four cases, patients died suddenly with no prior symptoms, and in eight cases the causes of death could not be fully determined. However, general survival has been good, particularly considering that surgery took place during the early years of open heart surgery. The results also support the current practice of operating on children with ventricular septal defects as soon as practical. (Consumer Summary produced by Reliance Medical Information, Inc.)