Abstract
Objective:To review the surgical outcome of doubly committed subarterial (DCSA) ventricular septal defect repair.Method:Data of 51 patients of doubly committed sub arterial Ventricular septal defect from January 2012 to June 2017 that were referred to Chaudhary Pervaiz Elahi institute of Cardiology Multan was retrospectively reviewed using electronic database. All patients were operated by first author. In our study, we segregated patients into four main groups depending on presence or absence of aortic structural defect and degree of aortic valve regurgitation. Group-A comprised of nineteen (37%) patients who neither had aortic structural nor functional abnormality while Group-B had six (11.7%) patients, having aortic valve cusp prolapse without aortic regurgitation. Group-C and Group-D consists of seventeen (33.3%) and nine (17.6%) patients respectively depending upon degree of aortic regurgitation. Furthermore, six (11.7%) patients among these 51 had associated defects as well.Results:Group-A patients had no aortic valve regurgitation post operatively and at follow up of 22.6 months (1.8 years) as well. In Group-B, aortic valve was not addressed and aortic regurgitation was also not present post operatively or on follow up of 33.6 months (2.8 years). Similarly, in Group-C aortic valve was not addressed, these patients also did not show progression of disease on regular follow up of 18 months (1.5 year). While, in Group-D, eight patients underwent aortic valve repair and one patient had aortic valve replacement. Aortic regurgitation improved significantly in all patients of this group and remained unchanged on follow up of 22.7 months (1.8 years).Conclusion:Early closure of doubly committed subarterial ventricular septal defect with appropriate management of aortic valve disease can halt the process of disease progression.
Highlights
doubly committed subarterial (DCSA) ventricular septal defects associated with Tetralogy of Fallot and other complex congenital defects were excluded from this study
Group-B consists of 6 patients with aortic valve structural abnormality in the form of cusp prolapse but without aortic regurgitation, so aortic valve was not addressed in these patients
VSD was small in 3, moderate in 5 and large in one patient. These patients had moderate to severe aortic valve disease.Aortic valve was repaired in 8 patients and replaced with 19 mm Saint Jude aortic valve metallic prosthesis in one patient
Summary
From January 2012 to June 2017, 51 patients of DCSA were referred to us for surgical consultation. The patients were diagnosed by routine 2-dimensional echocardiography and aortic regurgitation was graded by color Doppler echocardiography. VSD was categorized as large, moderate and small by comparing its size to aortic annulus diameter. Aortic regurgitation was graded mild, moderate and severe on the basis of color flow Doppler. Group-A comprised of 19 patients with no aortic regurgitation. In Group-C, 17 patients were included in whom aortic regurgitation was trace to mild and aortic valve was not addressed. Group-D constitutes of those 9 patients having moderate to severe aortic valve regurgitation aortic valve was repaired or replaced in these cases. Bidirectional shunt was present in 3 patients, one patient had right to left shunt because of associated severe pulmonary stenosis, rest had left to right shunt. In patients with moderate to severe aortic regurgitation, Aorta was opened. Table-I: DCSA VSD with Aortic Valve Physiology. Associated defects like PDA, ASD and pulmonary stenosis were repaired during procedure
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