Ventricular Septal Defect in the Adult

The adult with an unoperated ventricular septal defect presents several clinical and echocardiographic dilemmas.

• Echocardiographic shunt quantitation remains subjective and imprecise.
• Associated cardiac abnormalities must be identified.

Shunt quantitation in adults with ventricular septal defect is theoretically possible. Cardiac output can be calculated in the pulmonary artery and in the mitral inflow. In practice, however, both the pulmonary artery and the mitral annulus areas cannot be measured accurately enough. Visual assessment of the 2D images remains the initial approach in determining whether the defect is large.

A young adult presenting to the echocardiography laboratory with a newly discovered ventricular septal defect may be told that the defect is small and that no surgery is needed. This can be misinterpreted by the patient as reassurance that the clinical course will be benign. As a result, we intentionally explain in depth the importance of endocarditis prophylaxis.

Cardiac abnormalities associated with ventricular septal defects include other ventricular septal defects (muscular associated with perimembranous). It is obviously important to identify all defects when patients are being referred for surgery.

References:

Ellis JH IV, et al. Ventricular septal defect in the adult: Natural and unnatural history. Am Heart J 1987;114:115-20.

Weidman WH, et al. Clinical course in adults with ventricular septal defect. Circulation 1977;56:I78-9.

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