title: Does patch closure of subarterial ventricular septal defect affect the growth of pulmonary valve?
abstract: OBJECTIVE
  Patch closure of the subarterial ventricular septal defect requires suture placement at the pulmonary annulus. We aimed to identify whether patch closure of subarterial ventricular septal defect would affect the growth of pulmonary annulus in comparison with that of perimembranous ventricular septal defect.
  
  
  METHODS
  Of 361 patients who underwent patch closure of ventricular septal defect from January 1992 to December 1999, 98 (51 subarterial, 47 perimembranous) had echocardiographic data available for measurement of both preoperative and postoperative (more than 5 years after operation) pulmonary and aortic annular diameters. The pulmonary/aortic annular diameter ratio and their growth rates in the subarterial group were compared with those in the perimembranous group. The perioperative variables correlated with the pulmonary annular growth in subarterial group were also identified.
  
  
  RESULTS
  The mean follow-up duration was 7.2 years. Preoperative pulmonary/aortic annular diameter ratio was 1.45 (range, 0.94-2.31) in the subarterial group and 1.57 (range, 1.15-2.51) in the perimembranous group (p=0.059). The latest postoperative ratio was significantly lower in the subarterial group [subarterial: 1.02 (range, 0.77-1.41) vs perimembranous: 1.36 (range, 1.11-1.75), p<0.01]. Twenty-three patients (45%) in the subarterial group had the ratio less than 1. The pulmonary annular growth rate in the subarterial group was lower than that in the perimembranous group (subarterial: 0.34 mm/year, perimembranous: 1.03 mm/year, p<0.01). Preoperative pulmonary/aortic annular diameter ratio (r=0.885, p<0.01), age at operation (r=-0417, p<0.01), weight at operation (r=-0.357, p<0.05), and ventricular septal defect size (r=0.298, p<0.05) were found to have correlation with pulmonary annular growth in the subarterial group.
  
  
  CONCLUSIONS
  Our data show that pulmonary annular growth after patch repair of subarterial ventricular septal defect is suboptimal compared with perimembranous ventricular septal defect. Careful attention must be paid to the possible late clinical implication caused by impaired pulmonary annular growth after patch repair of subarterial ventricular septal defect.
authors: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, 1-10 Ami-dong, Seo-gu, Busan 602-739, South Korea.
authors: Yun Hee
authors: YH
authors: Chang
authors: Si Chan
authors: SC
authors: Sung
authors: Hyoung Doo
authors: HD
authors: Lee
authors: Ji Eun
authors: JE
authors: Ban
authors: Ki Seok
authors: KS
authors: Choo
authors: Young Seok
authors: YS
authors: Lee
mesh_terms: D000367:Age Factors; D001021:Aortic Valve / Q000473:pathology; D001794:Blood Pressure; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019736:Prostheses and Implants / Q000009:adverse effects; D011664:Pulmonary Valve / Q000254:growth & development* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011665:Pulmonary Valve Insufficiency / Q000209:etiology; D013537:Sutures / Q000009:adverse effects