Correlation of anatomic and hemodynamic features with aortic valve leafletdeformity in doubly committed subarterial ventricular septal defect

The records of 153 patients with doubly committed subarterial ventricular s eptal defect (DCVSD) who underwent intracardiac repair were analyzed to eva luate factors responsible for aortic valve leaflet deformity. The patients were divided into two groups according to their echocardiographic and angio graphic features as well as anatomic findings at operation: DCVSD without ( 17/153, 11.1%) and with arterial valve offsetting (136/153, 88.9%). Aortic regurgitation (AR) was much more prevalent in the patients with (50.0%) tha n in those without leaflet deformity (2.2%, P < 0.01). Arterial valve offse tting is one of the major contributing factors to the development of leafle t deformity, accounting for 5.9% in the patients without offsetting and 46. 3% in those with offsetting (P < 0.01). Among the patients with arterial va lve offsetting, the pulmonary-to-systemic pressure ratio was significantly higher (P < 0.01) in the patients without (0.76 +/- 0.14) than in those wit h leaflet deformity (0.36 +/- 0.12), suggesting that pulmonary hypertension might prevent the aortic valve leaflet from prolapsing in DCVSD. Ln additi on, increased severity of aortic valve leaflet deformity and subsequent AR were observed with increasing age. These results suggest that aging and the presence of arterial valve offsetting as well as the absence of pulmonary hypertension might be factors responsible for aortic valve leaflet deformit y and subsequent AR in DCVSD, The anatomic and hemodynamic features in DCVS D have a great impact on the development of aortic valve leaflet deformity and subsequent AR.