Outcome of surgical closure of doubly committed subarterial ventricular septal defect

Background From 1986 to March 1997, 128 patients diagnosed to have doubly c ommitted subarterial ventricular septal defects (VSD) were reviewed. Patien ts with aortic regurgitation (AR), and aortic valve (AV)deformity or a larg e left-to-right shunt across the VSD were offered operation. Forty-five pat ients (27 men, 18 women) agreed to surgical closure of their VSDs. Methods. Thirty-eight patients had VSD closure alone, and 7 had an addition al AV repair. Other associated defects corrected at operation were closure of atrial septal defects, closure of other ventricular septal defects, liga tion of patent ductus arteriosus, and repair of ruptured sinus Valsalva ane urysm. Results, There was no mortality nor major morbidity associated with operati on. In the 26 patients with AR and AV deformity preoperatively, valve repai r was performed in 6 patients. The condition of AR improved in 4, and remai ned unchanged in 22 patients. In the 10 patients with a deformity of the AV and no AR preoperatively, the condition remained unchanged in 5 patients, from whom 1 had valve operation, but progressed in 5 patients postoperative ly at a mean follow-up of 6.4 years. In 9 patients with no deformity of the AV and no AR preoperatively, there was no postoperative AR and no progress of valve deformity. Conclusions. Excellent results were obtained with VSD closure and AV repair . Surgical closure of VSD, if performed before the onset of AV deformity, m ay prevent progressive AR. If AV repair is performed after the onset of AV deformity, progressive AR may not always be prevented. (Ann Thorac Surg 199 9;67:736-8) (C) 1999 by The Society of Thoracic Surgeons.