Long-Term Outcome of Outlet-Type Ventricular Septal Defect: Focus on Congestive Heart Failure and Aortic Valve Disorder

Purpose: To investigate the outcome of outlet-type ventricular septal defect (VSD) after surgery in pediatric patients. Methods: A total of 152 children who underwent surgical repairs for outlet-type VSD were enrolled. Clinical features associated with development of congestive heart failure (CHF), aortic valve prolapse (AVP), and aortic regurgitation (AR) were analyzed. Results: CHF was noted in 34 (22.4%) of 152 patients. Patients with CHF had a larger VSD size (p < 0.0001), a higher Qp/Qs ratio (p < 0.0001), and a higher mean pulmonary pressure (p < 0.0001) compared with patients without CHF. AVP was noted in 106 (69.7%) of 152 patients. Patients with AVP had an older operation age (p < 0.0001), a smaller Qp/Qs ratio (p < 0.0001), a higher systolic pressure gradient between the left and right ventricles (p < 0.0001), and a higher diastolic pressure gradient between the aorta and the right ventricle (p = 0.022) compared with the patients without AVP. Among 43 (28.3%) patients with AVP and AR, 17 had mild and 4 had moderate-severe AR after surgery. Severe AVP (p = 0.0231) and pre-operative AR (p < 0.001) are two risk factors for the presence of postoperative residual AR. Conclusion: Long-term outcome of surgical repairs for outlet-type VSD is excellent in most pediatric patients without severe CHF or moderate-severe AR. AVP and AR are more frequent and severe in patients with delayed surgery, highlighting the importance of early surgical treatment of outlet-type VSD.