Residual Shunts Following Isolated Surgical Ventricular Septal Defect Closure: Risk Factors and Spontaneous Closure

  • Xicheng DengEmail author
  • Peng Huang
  • Jinwen Luo
  • Renwei Chen
  • Guangxian Yang
  • Wenjuan Chen
  • Qianjun Liu
  • Cheng He
Original Article


Although isolated congenital ventricular septal defects (VSD) can be repaired with a high degree of success, residual shunts (RS) are commonplace postoperatively. Small RS are relatively innocuous and tend to spontaneously close with time, despite the emotional burden it poses for the patient and family. A large RS, however, needs ongoing surveillance and may necessitate reintervention. Factors influencing the incidence of RS as well as the likelihood and expected timing of its spontaneous closure are discussed in this study. The patient records and relevant data of 362 consecutive patients undergoing cardiac operation with isolated congenital VSD closure as primary procedure between January 2017 and December 2017 were included in the study. Postoperative transthoracic echocardiograms were performed at hospital discharge, and during follow-up, at 1 month, 3 months, 6 months and 1 year postoperatively. Residual defects were measured under echocardiogram at every follow-up. Factors expected to be associated with RS occurrence and spontaneous closure were included for logistic and Cox regression statistical analysis. There were 113 cases where RS occurred according to the first postoperative echocardiograms that were performed at discharge, of which 80 were confirmed closed during subsequent follow-up, with a median follow-up of 96 days. A cutoff of 1.25 mm for the initial RS was found to be the best predictor of spontaneous closure at 6-month follow-up. Small shunts had higher closure rate than larger ones by a follow-up duration of 300 days, at which the two groups tended to reach a similar spontaneous closure rate. Longer surgical bypass time distinguished small from larger residual shunts measured upon discharge. Following repair of isolated congenital VSDs, the incidence of a residual shunt is high. The majority spontaneously close within 300 days following surgery. Longer bypass time predicted a larger residual shunt upon discharge. Larger than 1.25 mm shunts had lower short-term closure rate but seemed not to differ from smaller shunts beyond 300 days postoperatively.


Residual shunts Ventricular septal defect Surgery Spontaneous closure 



Residual shunt


Ventricular septal defect


Atrial septal defect


Patent foramen ovale


Patent ductus arteriosus


Right ventricular outflow tract stenosis/ pulmonary stenosis


Double outlet right ventricle


Transesophageal echocardiography


Transthoracic echocardiography


Intensive care unit


Cardiopulmonary bypass


Extracorporeal membrane oxygenation


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


  1. 1.
    Anderson BR, Stevens KN, Nicolson SC, Gruber SB, Spray TL, Wernovsky G, Gruber PJ (2013) Contemporary outcomes of surgical ventricular septal defect closure. J Thorac Cardiovasc Surg 145:641–647CrossRefGoogle Scholar
  2. 2.
    Penny DJ, Vick GW (2011) Ventricular septal defect. Lancet 377:1103–1112CrossRefGoogle Scholar
  3. 3.
    Schipper M, Slieker MG, Schoof PH, Breur JM (2017) Surgical repair of ventricular septal defect; contemporary results and risk factors for a complicated course. Pediatr Cardiol 38:264–270CrossRefGoogle Scholar
  4. 4.
    Meijboom F, Szatmari A, Utens E, Deckers JW, Roelandt JR, Bos E, Hess J (1994) Long-term follow-up after surgical closure of ventricular septal defect in infancy and childhood. J Am Coll Cardiol 24:1358–1364CrossRefGoogle Scholar
  5. 5.
    Yang SG, Novello R, Nicolson S, Steven J, Gaynor JW, Spray TL, Rychik J (2000) Evaluation of ventricular septal defect repair using intraoperative transesophageal echocardiography: frequency and significance of residual defects in infants and children. Echocardiography 17:681–684CrossRefGoogle Scholar
  6. 6.
    Rosenfeld HM, Gentles TL, Wernovsky G, Laussen PC, Jonas RA, Mayer JE Jr, Colan SD, Sanders SP, van der Velde ME (1998) Utility of intraoperative transesophageal echocardiography in the assessment of residual cardiac defects. Pediatr Cardiol 19:346–351CrossRefGoogle Scholar
  7. 7.
    Budczies J, Klauschen F, Sinn BV, Gyorffy B, Schmitt WD, Darb-Esfahani S, Denkert C (2012) Cutoff Finder: a comprehensive and straightforward Web application enabling rapid biomarker cutoff optimization. PloS ONE 7:e51862CrossRefGoogle Scholar
  8. 8.
    Dodge-Khatami A, Knirsch W, Tomaske M, Pretre R, Bettex D, Rousson V, Bauersfeld U (2007) Spontaneous closure of small residual ventricular septal defects after surgical repair. Ann Thorac Surg 83:902–905CrossRefGoogle Scholar
  9. 9.
    Ma XJ, Huang GY, Liang XC, Chen ZG, Jia B, Li X, Ye M (2007) Transoesophageal echocardiography in monitoring, guiding, and evaluating surgical repair of congenital cardiac malformations in children. Cardiol Young 17:301–306CrossRefGoogle Scholar
  10. 10.
    Randolph GR, Hagler DJ, Connolly HM, Dearani JA, Puga FJ, Danielson GK, Abel MD, Pankratz VS, O’Leary PW (2002) Intraoperative transesophageal echocardiography during surgery for congenital heart defects. J Thorac Cardiovasc Surg 124:1176–1182CrossRefGoogle Scholar
  11. 11.
    Stevenson JG, Sorensen GK, Gartman DM, Hall DG, Rittenhouse EA (1993) Transesophageal echocardiography during repair of congenital cardiac defects: identification of residual problems necessitating reoperation. J Am Soc Echocardiogr 6:356–365CrossRefGoogle Scholar
  12. 12.
    Hanna BM, El-Hewala AA, Gruber PJ, Gaynor JW, Spray TL, Seliem MA (2010) Predictive value of intraoperative diagnosis of residual ventricular septal defects by transesophageal echocardiography. Ann Thorac Surg 89:1233–1237CrossRefGoogle Scholar
  13. 13.
    Bol-Raap G, Weerheim J, Kappetein AP, Witsenburg M, Bogers AJ (2003) Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardio-Thorac Surg 24:511–515CrossRefGoogle Scholar
  14. 14.
    El Oakley R, Al Qethamy H, Al Saeedi A, Al Yousef S, Momenah TS, Al Faraidi Y (2008) Severity scoring system for ventricular septal defect. Pediatr Cardiol 29:1016–1017CrossRefGoogle Scholar
  15. 15.
    Preminger TJ, Sanders SP, van der Velde ME, Castaneda AR, Lock JE (1994) “Intramural” residual interventricular defects after repair of conotruncal malformations. Circulation 89:236–242CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Xicheng Deng
    • 1
    Email author
  • Peng Huang
    • 1
  • Jinwen Luo
    • 1
  • Renwei Chen
    • 1
  • Guangxian Yang
    • 1
  • Wenjuan Chen
    • 2
  • Qianjun Liu
    • 2
  • Cheng He
    • 3
  1. 1.Department of Cardiothoracic SurgeryHunan Children’s HospitalChangshaChina
  2. 2.Department of UltrasoundHunan Children’s HospitalChangshaChina
  3. 3.Department of Cardiothoracic SurgeryAlfred HospitalMelbourneAustralia

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