Silent VSD—An Update

Silent VSD—An Update

602 Silent VSD—An Update T. Goh ∗ Monash Medical Centre, Australia Objective: As is commonly understood, the clinical course of small VSD is an initia...

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602 Silent VSD—An Update T. Goh ∗ Monash Medical Centre, Australia Objective: As is commonly understood, the clinical course of small VSD is an initial loud pan systolic murmur that progressively softens and eventually disappears as the VSD closes. These signs are generally confirmed echocardiographically. However the condition where the murmur becomes silent clinically yet a VSD persists echocardiographically has only been recently described. Dynamics of closing VSD: There is progressive diminution of turbulent energy conversion to acoustic energy as VSD becomes smaller until a critical low level of acoustic energy is reached which makes the murmur inaudible to the human ear (the VSD persists on ECHO) hence “SILENT VSD” (svsd). Methods and results: I reviewed more than 150 of my VSD pts.on serial clinical and echo follow up for more 20 years and describe 16pts (12pvsd(4modpvsd), 4muscvsd) (aged 12–152 months, FU 12–151 months, mean 82.93, median 102, sd 46.72 months) that have svsd. The 4 pts with mod.pvsd have had longer FU 9 of these svsd pts have FU 12–63, mean 34.56, median 35, sd 17.61 months. 4 pts have now had complete echo closure FU 5–24, mean 15.75, median 17, sd 7.93 months. All patients remain well throughout the FU. Conclusion: 16 pts with silent VSD have been described with FU to 151 months. Of 9 pts FU 63 months, 4 have had complete echo closure. All have a good clinical course. Silent VSD is a newly observed clinical/echo entity and further observations and follow up are necessary to clarify its significance. doi:10.1016/j.hlc.2010.06.617 603 Structure–Function Correlates in Adults with Repaired Tetralogy of Fallot—A Cardiac MRI Study S. O’Meagher 1,2,∗ , P. Munoz 1,2 , J. Alison 1,2 , I. Young 1,2 , D. Tanous 1,3 , D. Celermajer 1,2 , R. Puranik 1,2 1 University

of Sydney, Australia Prince Alfred Hospital, Australia 3 Westmead Hospital, Australia 2 Royal

Background and aims: Presently, there are more adults with congenital heart disease (CHD) than children. Repaired tetralogy of Fallot (TOF) represents one of the largest groups of adults with CHD. Reduced exercise capacity has been reported in asymptomatic repairedTOF patients. We sought to determine the relationships between cardiac structure, function and exercise capacity in adult repaired-TOF patients.



Methods: 31 adults with repaired TOF (mean age ± SD at repair 3.4 ± 3.8 years; age at study 25 ± 8 years; range 15–46; 19 males) were recruited for cardiac MRI (1.5 T) and detailed cardiopulmonary exercise test with cycle ergometry. Results: Moderate pulmonary regurgitation (32 ± 17%) and right ventricular (RV) dilatation (RV end diastolic volume index 153 ± 51 mL) were observed. Bi-ventricular ejection fractions were maintained (LV: 55 ± 8% and RV: 50 ± 9%). Fibrosis was only occasionally detected in the RV outflow tract (n = 4). Peak oxygen uptake (VO2peak ) was 33 ± 8 ml/kg/min and peak work rate (Wpeak ) was 186 ± 55 W. The Wpeak % predicted normal (%Wpeak ) of 92 ± 18% was significantly higher than the VO2peak % predicted normal (%VO2peak ) of (79 ± 14% predicted, p = 0.006). Conclusions: VO2peak and Wpeak after TOF repair were higher than previously reported in US and UK series. These findings may in part be explained by earlier age at repair leading to lower rates of ventricular fibrosis and better preserved ventricular function. Higher %Wpeak compared to %VO2peak suggests extended periods of anaerobic metabolism may be utilised by these patients to achieve peak work. doi:10.1016/j.hlc.2010.06.618 604 Three-Dimensional Quantitative Analysis of Rheumatic Mitral Valve in Childhood: Inter-Observer Variation J. Mervis ∗ , M. Burrows, T. Gentles Green Lane Paediatric and Congenital Cardiac Service, New Zealand Background: Three-dimensional transoesophageal echocardiography (3D TOE) has potential to quantitate abnormalities of the mitral valve annulus and leaflets improving understanding of mitral valve dysfunction, and assisting surgical intervention. Reproducibility of available geometric indices is unknown. Aims: To assess reproducibility of 3D TOE quantitative analysis of rheumatic mitral valves in children with severe mitral regurgitation. Methods: Analysis of rheumatic mitral valves was undertaken by two independent operators using 3D TOE datasets obtained prior to surgery in 9 children aged 6–15 years with rheumatic heart disease. Results were compared and inter-observer agreement was assessed. Results: Images were adequate for analysis in 7 of 9. Inter-observer agreement was acceptable for six geometric parameters that involve measurement of the annulus shape and size (Table). Agreement was poor for the annular height:intercommisural width ratio which involves identification of the commisures and coaptation surface. Conclusion: Offline analysis of 3D TOE datasets can be performed with acceptable inter-observer agreement; measurement of the coaptation surface remains a challenge.


Heart, Lung and Circulation 2010;19S:S1–S268