Aneurysm of the membranous septum in adult patients with perimembranous ventricular septal defect

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Abstract
OBJECTIVE: The aneurysm of the membranous septum (AMS) has often beenconsidered as benign in the minds of many previous investigators. We haveanalyzed the complications with AMS in adult patients. METHODS: Fifty-onecases (20%) of AMS in 254 adult patients with perimembranous ventricularseptal defect (VSD) are described. The diagnosis of AMS was based onangiographic criteria. Thirty-nine (76.5%) of the 51 patients with AMS wereaged between 20 and 29 years. All patients but one with AMS had apulmonary-to-systemic flow (Qp/Qs) of less than 2.3 (range 1- 2.1, mean1.4). In a patient who had a ruptured aneurysm, the Qp/Qs was 2.7. Therewere six main complications affected by AMS and/or VSD; aortic valveprolapse in 24 patients (47%), aortic regurgitation in 15 (29.4%),tricuspid insufficiency in nine (17.6%), right ventricular outflow tractobstruction in two (4%), and rupture of the aneurysm in one patient (2%).Seven patients (13.7%) had prior bacterial endocarditis. All patientsunderwent surgery. Aneurysm and VSD were closed by direct suture in nineand with a patch in 42 patients. Aortic valve repair was performed in 13patients in whom regurgitation was mild to moderate, and replacement wasrequired in two patients with severe aortic regurgitation. RESULTS: Therewere no early or late deaths. Residual communication and recurrence of theaneurysm was noted three and seven years postoperatively in two patientswhere VSD had been closed by direct suture. CONCLUSIONS: According topresent data, aneurysm formation functionally reduces the VSD size, but ithas the potential consequence of promoting tricuspid insufficiency, aorticvalve prolapse, right ventricular outflow tract obstruction, rupture andbacterial endocarditis. Therefore, we recommend that AMS should be resectedcompletely and the defect produced closed with a patch in order to preventfurther enlargement and consequent complications even if there are nocardiac symptoms.

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