Progression of aortic regurgitation after surgical repair of outlet-type ventricular septal defects.
BACKGROUND
Progression of aortic regurgitation (AR) in repaired outlet ventricular septal defects (VSDs) remains unclear, especially for muscular outlet and perimembranous outlet VSDs. We tried to identify the risk factors for AR progression and aortic valve replacement (AVR) at long-term follow-up.


METHODS
Four hundred patients with complete follow-up after the repair of their outlet VSD between 1987 and 2002 were studied.


RESULTS
Juxta-arterial VSD, perimembranous outlet VSD, and muscular outlet VSD were noted in 190, 148, and 62 patients, respectively. There were 377 patients with none to mild AR (group I) and 23 with moderate to severe AR (group II) preoperatively. Aortic valve replacement was performed on 11 patients (all from group II), with 10 having received AVR concomitantly with VSD repair and 1 having received it 4 years later. Only severity of preoperative AR and older age (>15 years) at VSD repair were significant predictors of AVR. With a total follow-up of 2230 person-years, the 10-year freedom from AVR after VSD repair for group I was 100% and that for group II was 50.2%. In group I, AR progressed in 4 patients only (1.2%, 2 juxta-arterial and 2 perimembranous outlet) and aortic valvular (aortic valve prolapse or ruptured sinus Valsalva aneurysm) or subvalvular anomalies were present in all. The event-free (AR or AVR) survival rates among the 3 outlet-type VSDs however showed no difference.


CONCLUSIONS
Aortic regurgitation progression modes after surgical VSD repair were similar among the 3 outlet-type VSDs. Aortic valve replacement was rarely necessary for patients who were operated on when they were younger than 15 years. Aortic regurgitation of a less-than-moderate degree preoperatively rarely progressed after VSD repair.
Chiu
Shuenn-Nan
SN
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Wang
Jou-Kou
JK
Lin
Ming-Tai
MT
Chen
Chun-An
CA
Chen
Hui-Chi
HC
Chang
Chung-I
CI
Chen
Yih-Sharng
YS
Chiu
Ing-Sh
IS
Lue
Hung-Chi
HC
Wu
Mei-Hwan
MH
D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors