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Article: Impact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defect

TitleImpact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defect
Authors
Issue Date2002
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/athoracsur
Citation
Annals Of Thoracic Surgery, 2002, v. 73 n. 2, p. 622-627 How to Cite?
AbstractBackground. Previous reports on the long-term outcome of surgical closure of subarterial ventricular septal defect were based on a relatively small number of patients. Methods. We reviewed the long-term outcome of 135 patients who underwent closure of their defect and, in light of the findings, assessed the impact of preoperative aortic cusp prolapse and surgical interventions on occurrence of aortic regurgitation (AR) in the long-term. The patients were categorized into three groups for comparison: group I consisted of 79 patients with no aortic cusp prolapse and underwent simple closure of ventricular septal defect, group II comprised 39 patients with mild to moderate cusp prolapse who similarly had only closure of the defect performed, whereas group III comprised 17 patients who had additional aortic valvoplasty for greater than moderate to severe cusp prolapse. Results. Group I patients had significantly higher pulmonary arterial pressure (p < 0.001) and ratio of pulmonary blood flow to systemic blood flow (p < 0.001). None of these patients had AR before their operation, and none experienced AR afterward at a median follow-up of 6.1 years. Of the 39 group II patients, 30 (77%) had trivial or mild AR preoperatively. The AR improved in 15 patients, remained trivial or mild in 14 and absent in 7, but progressed to trivial or mild in 3 at a median follow-up of 3.1 years. None required further interventions. In contrast, 14 (82%) of the 17 group III patients had moderate to severe AR before operation. The regurgitation improved in 10, but remained moderate or severe in 4 and worsened further in 3 at a median follow-up of 4.6 years. The freedom from failure of aortic valvoplasty was (mean ± standard error of the mean) 71% ± 11%, 64% ± 12%, and 43% ± 19% at 1, 5, and 10 years, respectively. An older age at latest follow-up was the only identifiable significant risk factor (p = 0.03). Conclusions. Our data do not support the need of aortic valvoplasty for mild to moderate aortic cusp prolapse. Close follow-up is warranted in those with greater than moderate to severe cusp prolapse despite valvoplasty as there is continued failure on follow-up. Nothing, however, is better than early closure of defects before development of aortic valve complications. © 2002 by The Society of Thoracic Surgeons.
Persistent Identifierhttp://hdl.handle.net/10722/170315
ISSN
2015 Impact Factor: 2.975
2015 SCImago Journal Rankings: 1.490
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheung, YFen_US
dc.contributor.authorChiu, CSWen_US
dc.contributor.authorYung, TCen_US
dc.contributor.authorChau, AKTen_US
dc.date.accessioned2012-10-30T06:07:26Z-
dc.date.available2012-10-30T06:07:26Z-
dc.date.issued2002en_US
dc.identifier.citationAnnals Of Thoracic Surgery, 2002, v. 73 n. 2, p. 622-627en_US
dc.identifier.issn0003-4975en_US
dc.identifier.urihttp://hdl.handle.net/10722/170315-
dc.description.abstractBackground. Previous reports on the long-term outcome of surgical closure of subarterial ventricular septal defect were based on a relatively small number of patients. Methods. We reviewed the long-term outcome of 135 patients who underwent closure of their defect and, in light of the findings, assessed the impact of preoperative aortic cusp prolapse and surgical interventions on occurrence of aortic regurgitation (AR) in the long-term. The patients were categorized into three groups for comparison: group I consisted of 79 patients with no aortic cusp prolapse and underwent simple closure of ventricular septal defect, group II comprised 39 patients with mild to moderate cusp prolapse who similarly had only closure of the defect performed, whereas group III comprised 17 patients who had additional aortic valvoplasty for greater than moderate to severe cusp prolapse. Results. Group I patients had significantly higher pulmonary arterial pressure (p < 0.001) and ratio of pulmonary blood flow to systemic blood flow (p < 0.001). None of these patients had AR before their operation, and none experienced AR afterward at a median follow-up of 6.1 years. Of the 39 group II patients, 30 (77%) had trivial or mild AR preoperatively. The AR improved in 15 patients, remained trivial or mild in 14 and absent in 7, but progressed to trivial or mild in 3 at a median follow-up of 3.1 years. None required further interventions. In contrast, 14 (82%) of the 17 group III patients had moderate to severe AR before operation. The regurgitation improved in 10, but remained moderate or severe in 4 and worsened further in 3 at a median follow-up of 4.6 years. The freedom from failure of aortic valvoplasty was (mean ± standard error of the mean) 71% ± 11%, 64% ± 12%, and 43% ± 19% at 1, 5, and 10 years, respectively. An older age at latest follow-up was the only identifiable significant risk factor (p = 0.03). Conclusions. Our data do not support the need of aortic valvoplasty for mild to moderate aortic cusp prolapse. Close follow-up is warranted in those with greater than moderate to severe cusp prolapse despite valvoplasty as there is continued failure on follow-up. Nothing, however, is better than early closure of defects before development of aortic valve complications. © 2002 by The Society of Thoracic Surgeons.en_US
dc.languageengen_US
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/athoracsuren_US
dc.relation.ispartofAnnals of Thoracic Surgeryen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAortic Valve Insufficiency - Mortality - Surgery - Ultrasonographyen_US
dc.subject.meshAortic Valve Prolapse - Mortality - Surgery - Ultrasonographyen_US
dc.subject.meshChilden_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshEchocardiography, Doppler, Coloren_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHeart Septal Defects, Ventricular - Mortality - Surgery - Ultrasonographyen_US
dc.subject.meshHemodynamics - Physiologyen_US
dc.subject.meshHumansen_US
dc.subject.meshInfanten_US
dc.subject.meshMaleen_US
dc.subject.meshPostoperative Complications - Mortality - Ultrasonographyen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleImpact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defecten_US
dc.typeArticleen_US
dc.identifier.emailCheung, YF:xfcheung@hku.hken_US
dc.identifier.authorityCheung, YF=rp00382en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/S0003-4975(01)03393-8en_US
dc.identifier.pmid11848094-
dc.identifier.scopuseid_2-s2.0-0036162053en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036162053&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume73en_US
dc.identifier.issue2en_US
dc.identifier.spage622en_US
dc.identifier.epage627en_US
dc.identifier.isiWOS:000173624500058-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridCheung, YF=7202111067en_US
dc.identifier.scopusauthoridChiu, CSW=8714554800en_US
dc.identifier.scopusauthoridYung, TC=9132842300en_US
dc.identifier.scopusauthoridChau, AKT=35787094400en_US

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