Structural and functional alterations of the right ventricle are common in adults operated for ventricular septal defect as toddlers

Abstract

Aims: Patients with a surgically closed ventricular septal defect (VSD) contribute significantly to the increasing number of adults with congenital heart disease. The chronic effects of prior adverse haemodynamics in this population are incompletely understood. Our objective was to assess postoperative cardiac function and morphology in adult survivors of surgery in childhood.

Methods and results: Patients (n = 27), median surgical age of 1.9 (95% CI 1.1-2.8 years) and 20.5 (95% CI 19.6-22.1 years) at the time of examination, and age-matched controls (n = 28) underwent cardiac magnetic resonance imaging. We performed offline analyses of biventricular cardiac deformations, myocardial mass indices, flow patterns, and chamber areas and dimensions. In comparison with controls, VSD-operated patients had higher right ventricular (RV) areas; 36.8 ± 9.0 vs. 30.4 ± 6.4 cm(2) in end-diastole, P < 0.01, and 21.3 ± 5.9 vs. 16.0 ± 3.9 cm(2) in end-systole, P < 0.01. Furthermore, we found that fractional area change was lower among VSD-operated patients compared with controls; 0.42 ± 0.07 vs. 0.47 ± 0.05, P < 0.01, and we demonstrated a higher RV mass index in the VSD cohort compared with controls, P < 0.01. Radial strain was higher in the VSD group compared with controls; 30.2 ± 10.4 vs. 22.4 ± 7.7%, P < 0.01, whereas no difference was found in longitudinal strain; -20.1 ± 3.8% among VSD-operated patients vs. -21.5 ± 4.7% among controls, P = 0.28.

Conclusion: Left ventricular function is normal, but changes in RV structure and function are demonstrable 20 years after surgical closure of VSD. The mechanisms and implications for these findings justify a further study in this increasingly large population of adult survivors of early surgery.

Keywords: Adults with congenital heart disease; Cardiac magnetic imaging; Ventricular septal defect.