title: Frequency and operative correction of aortic insufficiency associated with ventricular septal defect.
abstract: Frequency and surgical results of aortic cusp prolapse and aortic regurgitation (AR) associated with ventricular septal defect (VSD) were studied. One hundred thirty-six consecutive patients with type I and II VSD according to Kirklin and associates' classification were divided into two groups; group A included 50 patients with type Ia VSD without the conal muscular rim, and group B included 86 patients with type Ib VSD with the conal muscular rim, or with type II VSD. Aortic cusp prolapse was detected in 74% of group A patients and 29% of group B patients. The aortic cusp prolapse correlated negatively with preoperative left-to-right shunt ratio, mean pulmonary artery pressure, and pulmonary-to-systemic pressure ratio in both groups. In group B patients, the smaller the VSD, the higher the frequency of aortic cusp prolapse, especially when less than 4 mm. Aortic regurgitation was observed in 44% of group A patients and 24% of group B patients. All 20 patients with first grade AR underwent VSD closure, 11 with second or third grade AR underwent VSD closure plus valvuloplasty, and 1 with third grade AR underwent aortic valve replacement. Postoperative persistent AR occurred in 8 out of 32 patients, and correlated positively (p < 0.01) with the preoperative grade of AR and the number of plication stitches in both groups.
authors.affiliation: Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Y
authors.initials: Y
authors.lastname: Morishita
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: I
authors.initials: I
authors.lastname: Yoshida
authors.forename: A
authors.initials: A
authors.lastname: Otaki
authors.forename: Y
authors.initials: Y
authors.lastname: Otani
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012720:Severity of Illness Index; D013536:Suture Techniques; D016896:Treatment Outcome