Analysis of indications for surgical closure of subarterial ventricular septal defect without associated aortic cusp prolapse and aortic regurgitation
| Autor: | Hung Li, Clement S. W. Chiu, Tak-cheung Yung, Maurice Ping Leung, Yiu-fai Cheung, Adolphus K.T Chau, Kin-Shing Lun |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Aortic valve
Heart Defects Congenital Heart Septal Defects Ventricular Male medicine.medical_specialty Cardiac Catheterization Heart disease Adolescent medicine.medical_treatment Aortic Valve Insufficiency Regurgitation (circulation) Asymptomatic Postoperative Complications Internal medicine medicine Humans Child Cardiac catheterization Aortic Valve Prolapse Heart septal defect business.industry Infant Newborn Infant medicine.disease Surgery medicine.anatomical_structure Treatment Outcome Echocardiography Heart failure Child Preschool cardiovascular system Cardiology Cusp (anatomy) Female medicine.symptom Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal Follow-Up Studies |
| Zdroj: | The American journal of cardiology. 87(11) |
| ISSN: | 0002-9149 |
| Popis: | Subarterial ventricular septal defect (VSD) is relatively common in Orientals. We reviewed the outcome of 214 patients (137 males) who were followed for 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 development of aortic valve deformities. Demographic data, transthoracic and transesophageal echocardiographic findings, cardiac catheterization results, and operative findings were reviewed. Kaplan-Meier actuarial analysis was performed to assess the development of aortic valve complications over time. Seventy-five patients with heart failure and pulmonary hypertension underwent 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 prolapse or aortic regurgitation (AR) on follow-up. In contrast, of the 139 asymptomatic patients managed conservatively, 102 (73%) developed aortic cusp prolapse, 78% of whom (80 of 102) developed AR. The prevalence of aortic cusp 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 prompted 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 patients 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, p0.001). All patients with aortic cusp prolapse and all but 1 with heart failure had a defect size ofor =5 mm. In conclusion, subarterial VSD ofor =5 mm should be closed as early as possible to prevent development of aortic cusp prolapse and AR. Asymptomatic patients with small defects5 mm could be managed conservatively. |
| Databáze: | OpenAIRE |
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