INTRAOPERATIVE TEE ASSESSMENT OF VENTRICULAR SEPTAL-DEFECT WITH AORTIC REGURGITATION

Background. It is desirable to repair but not replace the aortic valve in patients with ventricular septal defect and acquired aortic regurg itation. Precise definition of the valvar pathology with monitoring of its repair perioperatively would enhance the surgical management of t his condition. Methods. Fourteen consecutive patients (age, 10.6 +/- 6 years; weight, 29.7 +/- 5.7 kg) who underwent repair of ventricular s eptal defect with aortic regurgitation were studied by intraoperative transesophageal echocardiography. The severity of prolapse of each of the individual aortic cusps and its adjacent sinus was assessed and th e valvar regurgitation quantified by Doppler-derived regurgitant indic es. The echocardiographic and surgical findings were correlated and th e preoperative and postoperative echocardiographic data were compared to assess the effectiveness of operation. Results. Eight subarterial a nd six perimembranous defects were located accurately and their sizes (11.8 +/- 3.0 mm) correlated well (r = 0.80) with the surgical measure ments. Transesophageal echocardiography detected prolapse of the aorti c valve and its sinus in all 14 patients. The severity of prolapse was severe in 10, moderate in 4, and mild in 5 leaflets. On the basis of these findings, together with the Doppler-derived mean regurgitant ind ices, exploration of the valve and valvuloplasty were executed appropr iately in 12 of 14 patients. In all 14 patients, transesophageal echoc ardiography after bypass revealed no further cuspal prolapse and signi ficant reduction of the mean regurgitant index (0.55 +/- 0.23 to 0.17 +/- 0.15, p < 0.0001). Residual ventricular septal defect was detected in 5 patients and the only patient with significant shunting who requ ired reexploration was identified correctly. Conclusions. Intraoperati ve transesophageal echocardiography can assess effectively the surgica l repair of ventricular septal defect with aortic regurgitation and pr ovide information that directs and alters surgical plans to the benefi t of patients.