Objectives: The subpulmonary defects (SVSD) were followed longitudinal and the progress of Coronary Cusp Prolapse (CCP) and Aortic Incompetence (AI) were assessed regularly since birth.
Method: Patients diagnosed SVSD between 1972 and 1982 were followed prospectively, would only be referred for surgery with indications such as previous infective endocarditis, cardiomegaly, heart failure and patients’ choice. 45 patients diagnosed to have SVSD were regularly followed. Standard views of trans-thoracic echo were performed regularly to assess AI and CCP. At least one cardiac catheterization would be performed. The severity of CCP and AI was graded using the following system: 0=none, 1=mild, 2=moderate and 3=severe.
Results: There were 30 Doubly Commited VSD (DCVSD)(66.7%)and 15 Outlet Muscular (OMVSD) (33.3%). The mean age was 26 years (median 27 year, range 20 years to 36 years) and the mean follow up duration is 28 years. There were 31 males and 14 females. Nine (7 DCVSD, 2 OMVSD) were closed by patch closure. The three patients with large defects were all operated early at age of 12 – 13 years. For the 6 with small defects, 2 were operated because of patient’s choice, the others were operated because of indications mentioned above. Those who are not operated only have small subpulmonary VSD and mostly grade 1 AI and/ or CCP with minimal progression over 26 – 35 years.
Conclusion:This series of 45 Chinese patients shows that the small subpulmonary VSD are usually static and will not show much progression and can be followed and treated conservatively.