Analysis of indications for surgical closure of subarterial ventricular septal defect without associated aortic cusp prolapse and aortic regurgitation

Subarterial ventricular septal defect (VSD) is relatively common in Orienta ls. We reviewed the outcome of 214 patients (137 males) who were followed f or 8.6 +/- 5.2 years (range 0.1 to 24.3) and addressed the issue regarding the necessity and optimum timing of closing subarterial defects before deve lopment of aortic valve deformities. Demographic data, transthoracic and tr ansesophageal echocardiographic findings, cardiac catheterization results, and operative findings were reviewed. Kaplan-Meier actuarial analysis was p erformed to assess the development of aortic valve complications over time. Seventy-five patients with heart failure and pulmonary hypertension underw ent surgical closure of VSD at the age of 2.4 +/- 2.9 years. No patient had aortic cusp prolapse before operation and none developed aortic cusp prola pse or aortic regurgitation (AR) on follow-up. In contrast, of the 139 asym ptomatic patients managed conservatively, 102 (73%) developed aortic cusp p rolapse, 78% of whom (80 of 102) developed AR. The prevalence of aortic cus p prolapse and AR at 1, 5, 10, and 15 years old was 8%, 30%, 64%, and 83%, and 3%, 24%, 45%, and 64%, respectively. Significant prolapse or AR prompte d surgical closure of VSD with (n = 22) or without (n = 26) valvoplasty in 48 of 102 patients (47%). The size of the VSD was significantly larger in p atients with heart failure (9.6 +/- 3.3 mm) or aortic cusp prolapse (11.7 /- 4.1 mm) compared with those without heart failure (4.5 +/- 1.4 mm, p <0. 001). All patients with aortic cusp prolapse and all but 1 with heart failu re had a defect size of greater than or equal to5 mm. In conclusion, subart erial VSD of greater than or equal to5 mm should be closed as early as poss ible to prevent development of aortic cusp prolapse and AR. Asymptomatic pa tients with small defects <5 mm could be managed conservatively. (C) 2001 b y Excerpta Medica, Inc.