Ventricular septal defect closure in right coronary cusp prolapse and aortic regurgitation complicating VSD in the outlet septum: which treatment is most appropriate?
BACKGROUND
There is currently not a standardized technique for the sizing and shaping of surgical closure of the ventricular septal defect (VSD) patch in patients with right coronary aortic cusp prolapse and aortic regurgitation (AR) complicating VSD in the outlet septum.


METHODS
Forty-six VSD patients who had aortic valve prolapse were divided into groups DC (direct closure, n=19), and SPC (small patch closure, n=27). Preoperative and postoperative echocardiography with Doppler color flow interrogation was performed on all patients.


RESULTS
In the DC group, among seven patients who had aortic valve prolapse but no AR preoperative, one patient developed AR during postoperative follow-up period. In the remaining 12 patients who had mild AR associated with aortic valve prolapse prior to the procedure, AR was diminished in four and unchanged in six patients. However, AR was aggravated in two patients who required further operations for AV repair or replacement. In the SPC group, among the eight patients who had no preoperative AR, AR progressed in one patient postoperatively. In the remaining 19 patients who had mild AR, AR was diminished in 15 and unchanged in four. The outcome from the operative procedure was significantly better in the SPC group than DC group with mild preoperative AR (chi(2)=7.82; P<0.05).


CONCLUSIONS
Small patch closure for this type of VSD is safer and more reliable in improving mild AR than that of direct closure, especially in patients with mild AR.
Jian-Jun
Ge
G
Department of Cardiovascular Surgery, 1st Hospital of Anhui Medical University, Hefei, 218 Jixi Road, Hefei, Anhui 230022, China. gejanjun@mail.hf.ah.cn
Xue-Gong
Shi
S
Ru-Yuan
Zhou
Z
Min
Lin
L
Sheng-Lin
Ge
G
Shi-Bing
Zhang
Z
Qing-Yun
Gao
G
D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001023:Aortic Valve Prolapse / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D016896:Treatment Outcome