R. Brauner et al., SURGICAL-MANAGEMENT OF VENTRICULAR SEPTAL-DEFECT WITH AORTIC-VALVE PROLAPSE - CLINICAL CONSIDERATIONS AND RESULTS, European journal of cardio-thoracic surgery, 9(6), 1995, pp. 315-319
Aortic valve prolapse is found in over 5% of children with ventricular
septal defect (VSD). Although this association occurs mostly with dou
bly committed subarterial VSDs, in this study the predominant type of
VSD was perimembranous. In order to determine the need and timing for
surgery and whether the anatomical features of septal defect may influ
ence clinical management and outcome in this lesion, we reviewed our e
xperience with 28 consecutive patients, operated on for VSD with prola
psed aortic valve cusp, with or without aortic regurgitation. Twenty-t
wo patients had a perimembranous VSD and six had doubly committed VSD.
Aortic regurgitation was trivial or absent in nine patients, mild in
ten and moderate to severe in nine. Associated cardiac anomalies were
present in 18 patients, all having perimembranous VSD, and included ri
ght ventricular outflow tract (RVOT) obstruction (n = 6), discrete sub
aortic membrane (n = 4) or both (n = 8). None of these patients had mo
re than moderate aortic regurgitation. The patients underwent surgical
closure of the septal defect between the ages of 1.5 and 34 years of
age (median = 7). Sixteen patients having mild or trivial aortic regur
gitation underwent closure of the VSD only, and 12 patients underwent
VSD closure with aortic valvuloplasty. Valvuloplasty was required more
often in doubly committed VSDs (66%) and in the perimembranous type w
ithout associated anomalies (100%), and significantly less often in th
e presence of RVOT obstruction, subaortic membrane or both (22%). At f
ollow-up (up to 5 years, mean 18 months), the grade of aortic regurgit
ation was unchanged in 11 and decreased in 5 patients undergoing closu
re of the VSD only. Of the 12 patients undergoing valvuloplasty, the g
rade of aortic regurgitation decreased in 9 (from moderate or severe t
o mild or absent), and remained unchanged in 3. The anatomic type of V
SD was not related to surgical outcome. Aortic valve prolapse in patie
nts with perimembranous VSD and associated RVOT obstruction, discrete
subaortic membrane or both seems to be less severe and aortic regurgit
ation progression seems slower than in patients with doubly committed
VSD or perimembranous VSD with no other anomalies. In this subgroup, a
ortic prolapse may not constitute an indication for early surgical int
ervention.