Abstract
In patients with subarterial ventricular septal defect (VSD), the progression of aortic regurgitation (AR) still remains unclear. This review is to identify the incidence of AR progression after VSD repair and to determine the optimal operation timing for subarterial VSD repair with or without aortic valve prolapse or AR. From January 2002 to December 2015, 103 patients who underwent subarterial VSD repair alone at our hospital were reviewed. All patients routinely underwent echocardiography (echo) performed by our pediatric cardiologists. The operative approach was through the pulmonary artery in all patients. The median age of patients at operation was 10 months (range 3 to 16.5 months). Eighty-nine patients (86.4%) underwent subarterial VSD closure before the age of 4 years. In the preoperative evaluation, 27.2% (28 patients) of the patients showed more than faint degree AR. The mean follow-up duration after VSD repair was 6.6 ± 4.0 years. In the latest follow-up echo after VSD repair, four patients had more than mild degree AR owing to aortic valve abnormalities or delayed operation period. Among them, AR progression occurred in only one patient (0.98%). Early and accurate assessment of the anatomical morphology of the aortic valve and optimal operation timing may be important to achieve better outcomes after repair and to prevent the development of aortic valve complications.
Highlights
Subarterial ventricular septal defect (VSD) is relatively common in Asians
The present study aimed to identify the incidence of aortic regurgitation (AR) progression after VSD repair and to determine the optimal operation timing for subarterial VSD repair with or without aortic valve prolapse or AR
The indications for surgery were rapid breathing and/or failure to thrive due to congestive heart failure, recurrent respiratory infection such as pneumonia or bronchitis due to excessive blood flow to the lung, or occurrence and/or progression of aortic valve complications such as aortic valve prolapse, AR, or other standard indications for VSD closure
Summary
Subarterial ventricular septal defect (VSD) is relatively common in Asians. The incidence of subarterial VSD in Asian countries accounts for approximately one-quarter of all VSD cases requiring surgical closure, which is quite rare in Western populations. Patients with subarterial VSD, due to the lack of support of the aortic valve in the absence of the infundibular septum [1], are concerned about aortic valve prolapse and aortic regurgitation (AR), which eventually tend to deform the aortic valve and could possibly result in rupture of the sinus of Valsalva in adulthood [2,3,4]. For these reasons, surgical patch closure of the defect with or without concurrent aortic valve repair has been.
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