title: Measurement of Aortic Valve Coaptation and Effective Height Using Echocardiography in Patients with Ventricular Septal Defects and Aortic Valve Prolapse.
abstract: Decreased coaptation height in adults has been identified as a marker of early valve failure. We evaluated aortic valve coaptation and effective height in healthy children and in children with a ventricular septal defect (VSD) with aortic cusp prolapse (ACP), using echocardiography. We included 45 subjects with VSD with ACP, 27 did not develop aortic regurgitation (AR) by ACP and 18 developed AR by ACP, and 83 healthy children as controls. Aortic root anatomy was estimated using the parasternal long-axis view. We measured the diameter of aortic valve (AV), coaptation height (CH), and effective height (EH) of the aortic valve. We defined the ACH (CH/AV ratio) and AEH (EH/AV ratio) indices as follows: [Formula: see text]. There were significant differences in ACH and AEH between the groups (control vs VSD with ACP vs VSD with ACP and AR, median ACH [%], 35.1 vs 32.0 vs 22.1; median AEH [%], 52.0 vs 48.0 vs 34.4, respectively; P < 0.01]). Intra-cardiac repair (ICR) was performed in 15 cases. Significant increases were observed in ACH and AEH before and after ICR (median ACH [%], before: 27.0, after: 32.7, P < 0.05; median AEH (%), before 38.5, after 45.8, P < 0.05). Measurement of ACH and AEH may allow direct and non-invasive assessment of the severity of VSD with ACP, which could aid clinicians in determining the need and timing for surgical intervention.
authors.affiliation: Department of Pediatrics, Chutoen General Medical Center, Syoubugauraike 1-1, Kakegawa City, 436-8555, Japan. iwashima3617@gmail.com.
authors.forename: Satoru
authors.initials: S
authors.lastname: Iwashima
authors.affiliation: Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Uchiyama
authors.affiliation: Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takamichi
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Pediatric Cardiology, Nagano Children's Hospital, Azumino, Japan.
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Takigiku
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Pediatrics, Akita University Faculty of Medicine, Akita, Japan.
authors.forename: Manatomo
authors.initials: M
authors.lastname: Toyono
authors.affiliation: Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Inoue
authors.affiliation: Department of Pediatric Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Nii
mesh_terms: D000792:Angiography; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001023:Aortic Valve Prolapse / Q000000981:diagnostic imaging* / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007564:Japan; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies
keywords: Aortic cusp; Aortic regurgitation; Coaptation height; Congenital heart disease; Ventricular septal defects