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Aortic valvar involvement in patients undergoing closure of ventricular septal defect via the pulmonary trunk.
Int J Cardiol 2008; 129(1):26-31IJ

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.

CONCLUSION

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+Show Affiliations

Department of Cardio-thoracic Surgery and Cardiac Morphology, Royal Brompton Hospital, London, UK.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17692972

Citation

Uemura, Hideki, et al. "Aortic Valvar Involvement in Patients Undergoing Closure of Ventricular Septal Defect Via the Pulmonary Trunk." International Journal of Cardiology, vol. 129, no. 1, 2008, pp. 26-31.
Uemura H, Kagisaki K, Adachi I, et al. Aortic valvar involvement in patients undergoing closure of ventricular septal defect via the pulmonary trunk. Int J Cardiol. 2008;129(1):26-31.
Uemura, H., Kagisaki, K., Adachi, I., Takeda, K., Hagino, I., Yagihara, T., & Kitamura, S. (2008). Aortic valvar involvement in patients undergoing closure of ventricular septal defect via the pulmonary trunk. International Journal of Cardiology, 129(1), pp. 26-31.
Uemura H, et al. Aortic Valvar Involvement in Patients Undergoing Closure of Ventricular Septal Defect Via the Pulmonary Trunk. Int J Cardiol. 2008 Sep 16;129(1):26-31. PubMed PMID: 17692972.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aortic valvar involvement in patients undergoing closure of ventricular septal defect via the pulmonary trunk. AU - Uemura,Hideki, AU - Kagisaki,Koji, AU - Adachi,Iki, AU - Takeda,Koji, AU - Hagino,Ikuo, AU - Yagihara,Toshikatsu, AU - Kitamura,Soichiro, Y1 - 2007/08/13/ PY - 2007/01/31/received PY - 2007/04/04/revised PY - 2007/05/19/accepted PY - 2007/8/19/pubmed PY - 2009/2/12/medline PY - 2007/8/19/entrez SP - 26 EP - 31 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 129 IS - 1 N2 - 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. CONCLUSION: 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. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/17692972/Aortic_valvar_involvement_in_patients_undergoing_closure_of_ventricular_septal_defect_via_the_pulmonary_trunk_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(07)01117-5 DB - PRIME DP - Unbound Medicine ER -