title: Predictors for the Outcome of Aortic Regurgitation After Cardiac Surgery in Patients with Ventricular Septal Defect and Aortic Cusp Prolapse in Saudi Patients.
abstract: OBJECTIVE
  Aortic valve (AV) prolapse and subsequent aortic regurgitation (AR) are two complications of ventricular septal defects (VSD) that are located close to or in direct contact with the AV. This finding is one of the indications for surgical VSD closure even in the absence of symptoms to protect the AV integrity. The goal of our study was to assess the outcome and to identify the predictors for improvement or progression of AR after surgical repair.
  
  
  METHODS
  A retrospective study of all children with VSD and AV prolapse who underwent cardiac surgery at King Abdulaziz Cardiac Centre in Riyadh between July 1999 and August 2013.
  
  
  RESULTS
  A total of 41 consecutive patients, operated for VSD with prolapsed AV, with or without AR, were reviewed. The incidence of AV prolapse in the study population was 6.8% out of 655 patients with VSD. Thirty-six (88%) patients had a perimembranous VSD, and four had doubly committed VSD. Only one patient had an outlet muscular VSD. Right coronary cusp prolapse was found in 38 (92.7%) patients. Preoperative AR was absent in five patients, mild or less in 25 patients, moderate in seven, and severe in four patients. Twenty-six patients showed improvement in the degree of AR after surgery (Group A), 14 patients showed no change in the degree of AR (Group B) while only one patient showed the progression of his AR after surgery. Those with absent AR before surgery remained with no AR after surgery. Improvement was found more in those with mild degree of AR preoperatively compared to those with moderate and severe AR. Female gender also showed a tendency to improve more as compared to male.
  
  
  CONCLUSIONS
  Early surgical closure is advisable for patients with VSD and associated AV prolapse to achieve a better outcome after repair and to prevent progression of AR in future.
authors.affiliation: Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Section of Pediatric Cardiology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Hiba Gaafar
authors.initials: HG
authors.lastname: Salih
authors.affiliation: Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Section of Pediatric Cardiac ICU, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Sameh R
authors.initials: SR
authors.lastname: Ismail
authors.affiliation: Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Section of Pediatric Cardiac ICU, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Saud University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Kabbani
authors.affiliation: Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Section of Pediatric Cardiology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Saud University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Riyadh M
authors.initials: RM
authors.lastname: Abu-Sulaiman
keywords: Aortic regurgitation; coronary cusp prolapse; perimembranous ventricular septal defect