Article: Analysis of indications for surgical closure of subarterial ventricular septal defect without associated aortic cusp prolapse and aortic regurgitation

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TitleAnalysis of indications for surgical closure of subarterial ventricular septal defect without associated aortic cusp prolapse and aortic regurgitation
AuthorsLun, KS1
Li, H1
Leung, MP1
Chau, AKT1
Yung, TC1
Chiu, CSW1
Cheung, YF1 2
Issue Date2001
PublisherExcerpta Medica, Inc.. The Journal's web site is located at http://www.ajconline.org/
CitationAmerican Journal Of Cardiology, 2001, v. 87 n. 11, p. 1266-1270 [How to Cite?]
DOI: http://dx.doi.org/10.1016/S0002-9149(01)01517-X
AbstractSubarterial ventricular septal defect (VSD) is relatively common in Orientals. We reviewed the outcome of 214 patients (137 males) who were followed for 8.6 ± 5.2 years (range 0.1 to 24.3) and addressed the issue regarding the necessity and optimum timing of closing subarterial defects before development of aortic valve deformities. Demographic data, transthoracic and transesophageal echocardiographic findings, cardiac catheterization results, and operative findings were reviewed. Kaplan-Meier actuarial analysis was performed to assess the development of aortic valve complications over time. Seventy-five patients with heart failure and pulmonary hypertension underwent surgical closure of VSD at the age of 2.4 ± 2.9 years. No patient had aortic cusp prolapse before operation and none developed aortic cusp prolapse or aortic regurgitation (AR) on follow-up. In contrast, of the 139 asymptomatic patients managed conservatively, 102 (73%) developed aortic cusp prolapse, 78% of whom (80 of 102) developed AR. The prevalence of aortic cusp prolapse and AR at 1, 5, 10, and 15 years old was 8%, 30%, 64%, and 83%, and 3%, 24%, 45%, and 64%, respectively. Significant prolapse or AR prompted surgical closure of VSD with (n = 22) or without (n = 26) valvoplasty in 48 of 102 patients (47%). The size of the VSD was significantly larger in patients with heart failure (9.6 ± 3.3 mm) or aortic cusp prolapse (11.7 ± 4.1 mm) compared with those without heart failure (4.5 ± 1.4 mm, p <0.001). All patients with aortic cusp prolapse and all but 1 with heart failure had a defect size of ≥5 mm. In conclusion, subarterial VSD of ≥5 mm should be closed as early as possible to prevent development of aortic cusp prolapse and AR. Asymptomatic patients with small defects <5 mm could be managed conservatively. © 2001 Excerpta Medica, Inc.
ISSN0002-9149
2011 Impact Factor: 3.368
2011 SCImago Journal Rankings: 0.371
DOIhttp://dx.doi.org/10.1016/S0002-9149(01)01517-X
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorLun, KS
dc.contributor.authorLi, H
dc.contributor.authorLeung, MP
dc.contributor.authorChau, AKT
dc.contributor.authorYung, TC
dc.contributor.authorChiu, CSW
dc.contributor.authorCheung, YF
dc.date.accessioned2012-10-30T06:07:25Z
dc.date.available2012-10-30T06:07:25Z
dc.date.issued2001
dc.description.abstractSubarterial ventricular septal defect (VSD) is relatively common in Orientals. We reviewed the outcome of 214 patients (137 males) who were followed for 8.6 ± 5.2 years (range 0.1 to 24.3) and addressed the issue regarding the necessity and optimum timing of closing subarterial defects before development of aortic valve deformities. Demographic data, transthoracic and transesophageal echocardiographic findings, cardiac catheterization results, and operative findings were reviewed. Kaplan-Meier actuarial analysis was performed to assess the development of aortic valve complications over time. Seventy-five patients with heart failure and pulmonary hypertension underwent surgical closure of VSD at the age of 2.4 ± 2.9 years. No patient had aortic cusp prolapse before operation and none developed aortic cusp prolapse or aortic regurgitation (AR) on follow-up. In contrast, of the 139 asymptomatic patients managed conservatively, 102 (73%) developed aortic cusp prolapse, 78% of whom (80 of 102) developed AR. The prevalence of aortic cusp prolapse and AR at 1, 5, 10, and 15 years old was 8%, 30%, 64%, and 83%, and 3%, 24%, 45%, and 64%, respectively. Significant prolapse or AR prompted surgical closure of VSD with (n = 22) or without (n = 26) valvoplasty in 48 of 102 patients (47%). The size of the VSD was significantly larger in patients with heart failure (9.6 ± 3.3 mm) or aortic cusp prolapse (11.7 ± 4.1 mm) compared with those without heart failure (4.5 ± 1.4 mm, p <0.001). All patients with aortic cusp prolapse and all but 1 with heart failure had a defect size of ≥5 mm. In conclusion, subarterial VSD of ≥5 mm should be closed as early as possible to prevent development of aortic cusp prolapse and AR. Asymptomatic patients with small defects <5 mm could be managed conservatively. © 2001 Excerpta Medica, Inc.
dc.description.natureLink_to_subscribed_fulltext
dc.identifier.citationAmerican Journal Of Cardiology, 2001, v. 87 n. 11, p. 1266-1270 [How to Cite?]
DOI: http://dx.doi.org/10.1016/S0002-9149(01)01517-X
dc.identifier.doihttp://dx.doi.org/10.1016/S0002-9149(01)01517-X
dc.identifier.epage1270
dc.identifier.issn0002-9149
2011 Impact Factor: 3.368
2011 SCImago Journal Rankings: 0.371
dc.identifier.issue11
dc.identifier.pmid11377352
dc.identifier.scopuseid_2-s2.0-0035371337
dc.identifier.spage1266
dc.identifier.urihttp://hdl.handle.net/10722/170312
dc.identifier.volume87
dc.languageeng
dc.publisherExcerpta Medica, Inc.. The Journal's web site is located at http://www.ajconline.org/
dc.publisher.placeUnited States
dc.relation.ispartofAmerican Journal of Cardiology
dc.relation.referencesReferences in Scopus
dc.subject.meshAdolescent
dc.subject.meshAortic Valve Insufficiency - Surgery - Ultrasonography
dc.subject.meshAortic Valve Prolapse - Surgery - Ultrasonography
dc.subject.meshChild
dc.subject.meshChild, Preschool
dc.subject.meshEchocardiography
dc.subject.meshEchocardiography, Transesophageal
dc.subject.meshFemale
dc.subject.meshFollow-Up Studies
dc.subject.meshHeart Catheterization
dc.subject.meshHeart Defects, Congenital - Surgery - Ultrasonography
dc.subject.meshHeart Septal Defects, Ventricular - Surgery - Ultrasonography
dc.subject.meshHumans
dc.subject.meshInfant
dc.subject.meshInfant, Newborn
dc.subject.meshMale
dc.subject.meshPostoperative Complications - Ultrasonography
dc.subject.meshTreatment Outcome
dc.titleAnalysis of indications for surgical closure of subarterial ventricular septal defect without associated aortic cusp prolapse and aortic regurgitation
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong
  2. Grantham Hospital Hong Kong