Aortic regurgitation and aortic valve cusp deformity in ventricular septal defect in India

Abstract

A prospective study of 50 consecutive cases of ventricular septal defects (VSD) by aortic root cine angiocardiography in two projections is reported. Aortic valve cusp deformity (AVCD) was found in 43 cases (86%). The AVCD involved the non-coronary cusp (NCC) alone in 50%, right coronary cusp (RCC) and NCC in 14%, RCC alone in 18% and left coronary cusp (LCC) alone in 4% of cases. Relating AVCD to the type of VSD, four of five cases with supracristal VSD and 37 of 45 cases with infracristal VSD had AVCD. Aortic regurgitation (AR) was found in 34% of cases, as compared with 14.5% in an earlier retrospective study of 350 cases of VSD. AR was mild in 24%, moderate in 8% and severe in 2% of cases. The jet of AR was to the left ventricle (LV) alone in 22% and to both the right ventricle (RV) and LV in 12% of cases; the NCC was involved in ten (20%) and the NCC plus the RCC in four (8%), the RCC alone in two (4%) and the LCC alone in no patients. All patients except one with AR had AVCD. AR does not appear to influence the development of pulmonary hypertension, as 34 patients (68%) had normal pulmonary artery (PA) pressure, including one patient with severe AR. Two patients with AVCD without AR pre-operatively developed AR 6 months and 1 year after VSD closure and none had residual VSD.