title: Aortic valvar involvement in patients undergoing closure of ventricular septal defect via the pulmonary trunk.
abstract: BACKGROUND
  To determine how often the aortic valve is involved in doubly-committed ventricular septal defect in a surgical series, and when to intervene to minimize aortic valvar impediments.
  
  
  METHODS
  The defect was surgically closed in 415 patients via the pulmonary trunk, age at operation ranging from 2 months to 76 years old. In infants, pulmonary hypertension or pulmonary high flow was the exclusive indication. Any progressive deformity of the aortic leaflet or aortic regurgitation was an alternative principal indication in older children or adolescents. No additional manoeuvres were employed for the aortic root unless aortic regurgitation is more than slight. Otherwise, the aortic valve was repaired or replaced. When the sinus of Valsalva was significantly deformed or ruptured, the structure was surgically restored.
  
  
  RESULTS
  Significant aortic regurgitation or the ruptured sinus of Valsalva was increasingly found beyond the paediatric age. Bacterial endocarditis was seen in 8% of adults or adolescents. Silent herniation of the aortic leaflet was not uncommon after 4 years old, seen in more than 40% of patients. Need of aortic valvar repair was rare before 2 years old, and in approximately 10% between 2 and 15 years old. Freedom from reoperation was 89% at 10 years and 78% at 25 years after aortic valvar repair, and 91% and 84%, respectively, after replacement, versus 100% and 99.4%, respectively, after no additional valvar procedure.
  
  
  CONCLUSIONS
  Aortic valvar involvement was rare, and ventricular septal defect was closed without impediments, before 2 years old. Surgery should be arranged before any additional aortic valvar manoeuvre is needed.
authors: Department of Cardio-thoracic Surgery and Cardiac Morphology, Royal Brompton Hospital, London, UK.
authors: Hideki
authors: H
authors: Uemura
authors: Koji
authors: K
authors: Kagisaki
authors: Iki
authors: I
authors: Adachi
authors: Koji
authors: K
authors: Takeda
authors: Ikuo
authors: I
authors: Hagino
authors: Toshikatsu
authors: T
authors: Yagihara
authors: Soichiro
authors: S
authors: Kitamura
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D006345:Heart Septal Defects, Ventricular / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011651:Pulmonary Artery / Q000502:physiology / Q000601:surgery*