title: Severity indices of right coronary cusp prolapse and aortic regurgitation complicating ventricular septal defect in the outlet septum: which defect should be closed?
abstract: BACKGROUND
  The factors that may determine the evolution of right coronary cusp prolapse (RCCP) and regurgitation (AR) associated with a ventricular septal defect in the outlet septum (outlet VSD) have not been clarified.
  
  
  RESULTS
  The Doppler echocardiograms of 316 patients were grouped according to both the development of RCCP, and the values of the right coronary cusp deformity index (RCCD) and the right coronary cusp imbalance index (R/L). All detected AR was </= slight, and not progressive in patients with both RCCD <0.30 and R/L <1.30. Moderate AR was detected in patients with either RCCD >/=0.30 or R/L >/=0.30. Rupture of the sinus of Valsalva was identified in patients with RCCD >/=0.30. A significantly large number of patients with both RCCD >/=0.30 and R/L >/=1.30 (p<0.01), and a few patients with either RCCD >/=0.30 or R/L >/=0.30 underwent aortic valvuloplasty or replacement. Operative outcome for AR </= slight was good.
  
  
  CONCLUSIONS
  There is no need to close an outlet VSD with RCCP when the RCCD <0.30 and R/L <1.30 as long as the AR remains trivial, but such defects should be closed when the RCCD is >/=0.30 or R/L >/=1.30.
authors.affiliation: Departments of Pediatrics, National Cardiovascular Center, Suita, Osaka, Japan. tomitah@sapmed.ac.jp
authors.forename: Hideshi
authors.initials: H
authors.lastname: Tomita
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Arakaki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ono
authors.forename: Osamu
authors.initials: O
authors.lastname: Yamada
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Yagihara
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Echigo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology*; D001023:Aortic Valve Prolapse / Q000175:diagnosis / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index