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VSD Closure in Adults Linked to Low Mortality, Morbidity

Findings support use of patch, transesophageal echocardiography in adult septal defect closure

THURSDAY, March 25 (HealthDay News) -- Ventricular septal defect (VSD) closure in adults results in low mortality and morbidity, and patch closure and intraoperative transesophageal echocardiography are linked to better surgical outcomes, according to research published in the March issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

François-Pierre Mongeon, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues analyzed data from 46 patients who underwent surgical VSD closure over a 50-year period. The most common indications for closure were aortic regurgitation, left ventricular dilation, and pulmonary hypertension. Coexisting congenital or acquired structural heart lesions were the main motivation for surgery in 18 patients.

According to the researchers, no operative mortality occurred. Morbidity included a high-grade atrioventricular block, as well as residual VSD in seven patients. Late mortality over 10.3 years of mean follow-up was only 5 percent. Late residual VSDs were more common after suture closure, and less common in patients who had intraoperative transesophageal echocardiography (IOTEE). Late moderate aortic regurgitation occurred in five patients who had aortic valve or sinus of Valsalva repair.

"The VSD patch closure appears to be the technique of choice given that residual VSDs occurred more often after suture closure. We support the routine use of IOTEE guidance because it may lead to less late aortic valve regurgitation, tricuspid valve regurgitation, and residual VSDs. These data emphasize important residua and the need for life-long informed cardiology follow-up," the authors conclude.

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