title: Left Ventricular Outflow Tract Obstruction in Aortic Arch Anomalies With Ventricular Septal Defect.
abstract: BACKGROUND
  The predictors of left ventricular outflow tract obstruction (LVOTO) after the repair of coarctation of the aorta or interruption of the aortic arch (CoA/IAA) with ventricular septal defect have been investigated. However, the predictors remain controversial.
  
  
  METHODS
  We performed primary repair of CoA/IAA with ventricular septal defect for 75 patients from 1996 to 2005. Four of the 75 patients died within 5 years after primary repair without relation to LVOTO. The morphology of the aortic valve of 71 survivors was bicuspid in 23 patients and tricuspid in 48 patients. The mean follow-up was 9.2 ± 2.6 years after primary repair.
  
  
  RESULTS
  There were 12 patients who showed LVOTO of 3.0 m/s or greater after primary repair. All of the 6 bicuspid patients demonstrated valvular aortic stenosis, and all of the 6 tricuspid patients showed discrete subvalvular LVOTO. In 5 of the 6 tricuspid patients, the aortic annular z-score before primary repair was -3.0 or less. A bicuspid aortic valve (p = 0.016) and the aortic annular z-score of -3.0 or less (p = 0.019) were significant risk factors for LVOTO after primary repair. At 10 years after primary repair, 82.6% and 95.6% of the bicuspid and tricuspid patients, respectively, were free from reoperation (p = 0.015).
  
  
  CONCLUSIONS
  The presence of a bicuspid aortic valve and an aortic valve annular z-score of -3.0 or less before primary repair are risk factors for LVOTO, and stenotic bicuspid valves and discrete subvalvular LVOTO are the main causes of LVOTO after primary repair of CoA/IAA with ventricular septal defect. The bicuspid patients more frequently required reoperation than the tricuspid patients.
authors.affiliation: Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Higashi-ku, Fukuoka, Japan. Electronic address: junyafine@hotmail.com.
authors.forename: Junya
authors.initials: J
authors.lastname: Sugiura
authors.affiliation: Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Higashi-ku, Fukuoka, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Nakano
authors.affiliation: Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Higashi-ku, Fukuoka, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kado
mesh_terms: D000015:Abnormalities, Multiple / Q000401:mortality / Q000601:surgery; D001013:Aorta, Thoracic / Q000002:abnormalities*; D001017:Aortic Coarctation / Q000150:complications* / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D018618:Echocardiography, Doppler, Color; D004933:Esophageal Atresia / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000601:surgery; D006349:Heart Valve Diseases / Q000150:complications* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery