RESUMO
BACKGROUND: With the rapid development of transcatheter techniques and instruments, transcatheter occlusion for patients with perimembranous ventricular septal defect (pVSD) and aortic valve prolapse (AVP) was constantly being tried, while the efficacy and safety of pVSD with AVP remain controversial. OBJECTIVE: The aim of this study was to evaluate long-term efficacy and safety of transcatheter occlusion of pVSD with AVP. METHODS: We retrospectively analyzed 164 children with pVSD and AVP who underwent transcatheter occlusion between January 2013 and November 2014. AVP was divided into 3 degrees according to right coronary leaflet morphology at end-diastole during aortic root angiography. Patient demographic and clinical data were collected. RESULTS: There were 97 males and 67 females (median age, 40.0 (30.0-62.7) months; average weight, 16.94 ± 9.02 kg). Mild (n = 63), moderate (n = 89), and severe (n = 12) AVP success rates were 93.7%, 89.9%, and 58.3%, respectively. Immediately after procedure, there was no new-onset aortic regurgitation (AR) above trivial degree, residual shunt above mild degree, or complications requiring medication or operation, except for 1 patient who developed transient complete atrioventricular block. During follow-up, 1 mild AVP patient aggravated from mild to moderate AR and 1 moderate AVP patient aggravated from trivial to moderate AR. The new-onset AR in mild, moderate, and severe AVP was 2%, 1.8%, and 20%, respectively. AR disappeared in 17 patients. Residual shunt occurred in 9 patients after procedure, 4 of which disappeared during the follow-up period. No serious complications occurred in any patient during follow-up. Five-year cardiovascular event-free survival rates for mild, moderate, and severe AVP were 89.6%, 94.5%, and 80.0%, respectively. CONCLUSION: Transcatheter occlusion of pVSD with mild and moderate AVP has a high success rate and few complications, which is safe and effective in long-term follow-up. Transcatheter occlusion of pVSD with severe AVP has low success rates and high AR incidence. Therefore, transcatheter occlusion of pVSD with AVP is recommended for mild to moderate, but not severe, AVP.
Assuntos
Prolapso da Valva Aórtica/cirurgia , Cateterismo Cardíaco/métodos , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal , Prolapso da Valva Aórtica/complicações , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Humanos , Masculino , Estudos RetrospectivosAssuntos
Filaminas/genética , Doenças Pulmonares Intersticiais/diagnóstico , Pulmão/patologia , Mutação , Prolapso da Valva Aórtica/complicações , Dor no Peito/etiologia , Tosse/etiologia , Diagnóstico Diferencial , Dispneia/etiologia , Feminino , Cardiopatias Congênitas/complicações , Heterozigoto , Humanos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/genética , Heterotopia Nodular Periventricular/genética , Enfisema Pulmonar/congênito , Enfisema Pulmonar/cirurgia , Testes de Função Respiratória , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
The medical records of 2283 patients with ventricular septal defect (VSD) were reviewed to determine spontaneous closure, left ventricular-to-right atrial shunt, subaortic ridge, and aortic valve prolapse. One thousand eight hundred and twenty-three patients had been followed 1 month to 26 years (median 4 years) by echocardiography. Most of 460 patients could not be followed due to transportation of the institution. VSD was perimembranous in 68.8% (1255), trabecular muscular in 21.7% (395), muscular outlet in 6% (109), muscular inlet in 2.6% (48), and doubly committed subarterial in 0.9% (16). Defect size was classified in 66.8% (1218) as small, in 15.7% (286) as moderate, and in 17.5% (319) as large. VSD closed spontaneously in 18.8% (343 of 1823 patients) by ages 40 days to 24.9 years (median, 1.8 years). One hundred fifty-seven of 1255 perimembranous defects (12.5%) and 167 of 395 trabecular muscular defects (42%) closed spontaneously (p < 0.001). Defect size became small in 306 (16.8%) of patients with VSD at a median of 2.5 years. Aneurysmal transformation was detected in 32.9% (600), left ventricular-to-right atrial shunt in 9.7% (176), subaortic ridge in 2.6% (48) of 1823 patients who were followed. In 381 (20.9%) of the 1823 patients, the VSD had been closed by a surgical or transcatheter technique. Surgery is required in one-fifth of patients with subaortic ridge or aortic valve prolapse. In conclusion, isolated VSDs are usually benign abnormalities that tend to shrink and close spontaneously.
Assuntos
Comunicação Interventricular , Adolescente , Adulto , Prolapso da Valva Aórtica/complicações , Criança , Pré-Escolar , Ecocardiografia , Feminino , Comunicação Interventricular/classificação , Comunicação Interventricular/complicações , Comunicação Interventricular/fisiopatologia , Comunicação Interventricular/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Fluxo Sanguíneo Regional , Remissão Espontânea , Adulto JovemRESUMO
BACKGROUND: Transcatheter closure is a well-established therapy for patients with perimembranous ventricular septal defects (VSDs), but with limited experience in intracristal VSDs (IVSDs) with aortic cusp prolapse (ACP). METHODSâANDâRESULTS: From 2012 to 2014, we reviewed 38 patients with IVSDs complicated with mild ACP who underwent device closure, and, in light of the findings, assessed the effect of transcatheter intervention on preoperative mild ACP. The zero eccentric VSD occluder was chosen for closure (Shanghai Shape Memory Alloy Ltd, Shanghai, China). The mean defect was 4.8±1.6 mm (range, 2-8) as measured by transthoracic echocardiography and the mean device size was 10.1±2.1 mm (range, 4-14). Placement of the device was successful in 35 patients (92.1%). In the remaining 3 patients (7.9%), major complications occurred and they were converted to surgical intervention: severe aortic regurgitation (AR) in 2 patients and occluder dislodgement in 1 patient. During the follow-up (median 14.2 months; range, 3-24), no deaths, residual shunt, late-onset AR, heart block, or device failure occurred. CONCLUSIONS: The mid-term prognostic results of high success rate and low complications rate in this study are inspiring. Transcatheter closure of IVSD with mild ACP can be performed safely and effectively as an alternative to surgery in selected patients.
Assuntos
Prolapso da Valva Aórtica , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia , Comunicação Interventricular , Recuperação de Função Fisiológica , Adolescente , Adulto , Prolapso da Valva Aórtica/complicações , Prolapso da Valva Aórtica/diagnóstico por imagem , Prolapso da Valva Aórtica/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Prolapso da Valva Aórtica/complicações , Dispneia/diagnóstico , Próteses Valvulares Cardíacas/efeitos adversos , Adulto , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/etiologia , Síndrome de Behçet/complicações , Diagnóstico Diferencial , Dispneia/etiologia , Ecocardiografia Doppler/métodos , Evolução Fatal , Humanos , Masculino , Índice de Gravidade de Doença , Choque Cardiogênico/diagnósticoRESUMO
OBJECTIVE: Although many studies have evaluated the impacts of obesity on various medical treatments, it is not known whether obesity is related to late mortality with implantation of small aortic prosthesis. This study evaluated the effect of obesity on late survival of patients after aortic valve replacement (AVR) with implantation of small aortic prosthesis (size ≤ 21 mm). METHODS: From January 1998 to December 2008, 536 patients in our institution who underwent primary AVR (307 patients with smaller prostheses) survived the 30 days after surgery. Patients were categorised as normal weight if body mass index (BMI) was ≤ 25 kg/m(2), as overweight if BMI 25-30 kg/m(2), and as obese if BMI ≥ 30 kg/m(2). Data were collected at the third-month (M), sixth-M, first-year (Y), third-Y, fifth-Y, and eighth-Y after operation. RESULTS: By multivariable analysis, obesity was a significant independent factor of late mortality (hazard ratio [HR]: 1.59; p=0.006). The obese and overweight groups of patients exhibited lower survival (p<0.001) and a higher proportion in NYHA class III/IV (p<0.01) compared with the normal group. Lower EOAI and higher left ventricular mass index were found in the obese and overweight groups, but we saw no significant variance in LVEF among the three groups. CONCLUSIONS: Obesity was associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Being obese or and overweight may also affect the NYHA classification, even in the longer term.
Assuntos
Prolapso da Valva Aórtica/mortalidade , Prolapso da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Obesidade/mortalidade , Adulto , Idoso , Prolapso da Valva Aórtica/complicações , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/cirurgia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Ventricular septal defects (VSD) are the most common congenital heart diseases in children. Among them, perimembranous VSD (pm-VSD) have a higher risk of complications, including aortic valve prolapse and aortic regurgitation (AR). The aim of our study was to assess echocardiographic criteria associated with AR during follow-up of pm-VSD. Forty children with restrictive pm-VSD, followed-up in our unit and who underwent a workable echocardiographic evaluation between 2015 and 2019 were included and retrospectively analyzed. The propensity score was used to match 15 patients with AR to 15 patients without AR. Median age was 2.2 year [1.4-5.7]. Median weight was 14 kg [9.9-20.3]. Aortic annulus z-score, Valsalva sinus z-score, sinotubular junction z-score, valve prolapse and commissure commitment were significantly different between the two groups (p = 0.047, p = 0.001, p = 0.010, p = 0.007, p < 0.001 respectively). Aortic root dilatation, aortic valve prolapse and commissure commitment to a perimembranous VSD are associated to aortic regurgitation.
Assuntos
Insuficiência da Valva Aórtica , Prolapso da Valva Aórtica , Comunicação Interventricular , Humanos , Criança , Pré-Escolar , Prolapso da Valva Aórtica/complicações , Estudos Retrospectivos , Comunicação Interventricular/epidemiologia , Ecocardiografia/efeitos adversosRESUMO
BACKGROUND: Aortic regurgitation (AR) is one of the most common cardiac valvular diseases, and it is frequently caused by cusp prolapse. However, the precise relationship of commissure position and aortic cusp prolapse with AR is not fully understood. In this study, we developed a 3D-printed commissure geometric alignment device to investigate the effect of commissure height and inter-commissure angle on AR and aortic cusp prolapse. METHODS: Three porcine aortic valves were explanted from hearts obtained from a meat abattoir and were mounted in the commissure geometric alignment device. Nine commissure configurations were tested for each specimen, exploring independent and concurrent effects of commissure height and inter-commissure angle change on AR and aortic cusp prolapse. Each commissure configuration was tested in our 3D printed ex vivo left heart simulator. Hemodynamics data, echocardiography, and high-speed videography were obtained. RESULTS: AR due to aortic cusp prolapse was successfully generated using our commissure geometric alignment device. Mean aortic regurgitation fraction measured for the baseline, high commissure, low commissure, high commissure and wide inter-commissure angle, high commissure and narrow inter-commissure angle, low commissure and wide inter-commissure angle, low commissure and narrow inter-commissure angle, wide commissure, and narrow commissure configurations from all samples were 4.6 ± 1.4%, 9.7 ± 3.7%, 4.2 ± 0.5%, 11.7 ± 5.8%, 13.0 ± 8.5%, 4.8 ± 0.9%, 7.3 ± 1.7%, 5.1 ± 1.2%, and 7.1 ± 3.1%, respectively. CONCLUSIONS: AR was most prominent when commissure heights were changed from their native levels with concomitant reduced inter-commissure angle. Findings from this study provide important evidence demonstrating the relationship between commissure position and aortic cusp prolapse and may have a significant impact on patient outcomes after surgical repair of aortic valves.
Assuntos
Insuficiência da Valva Aórtica , Prolapso da Valva Aórtica , Doenças das Valvas Cardíacas , Animais , Suínos , Insuficiência da Valva Aórtica/complicações , Prolapso da Valva Aórtica/cirurgia , Prolapso da Valva Aórtica/complicações , Estudos Retrospectivos , Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/complicaçõesRESUMO
INTRODUCTION: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. METHODS: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). RESULTS: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. CONCLUSION: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.
Assuntos
Insuficiência da Valva Aórtica , Prolapso da Valva Aórtica , Comunicação Interventricular , Idoso , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/cirurgia , Prolapso da Valva Aórtica/complicações , Prolapso da Valva Aórtica/diagnóstico por imagem , Prolapso da Valva Aórtica/cirurgia , Comunicação Interventricular/complicações , Comunicação Interventricular/cirurgia , Humanos , Prolapso , Estudos Retrospectivos , Síndrome , Resultado do TratamentoRESUMO
PURPOSE: To compare magnetic resonance imaging (MRI) with transthoracic echocardiography (TTE) in the diagnosis of coronary cusp prolapse (CCP) as a complication of ventricular septal defect (VSD). MATERIALS AND METHODS: Twenty-three patients (10 males, 13 females, mean age 9 years) with clinically suspected CCP were included in a retrospective study. Long and short axis cine images and electrocardiogram (ECG)-gated axial T1-weighted image MRI images were evaluated for deformity and protrusion of right and noncoronary cusps. We compared MRI and TTE results. We compared the agreement between MRI and TTE in outlet VSD and membranous VSD. RESULTS: On MRI, 19 patients had right coronary cusp prolapse (RCCP), three had noncoronary cusp prolapse (NCCP), and one patient had RCCP and NCCP on MRI. Twenty-two patients had RCCP on TTE and none had NCCP. Seventeen patients had outlet defects and six patients had a membranous defect at operation. All patients with an outlet VSD had RCCP on both MRI and TTE. The agreement between MRI and TTE in outlet VSD was better than in membranous VSD. CONCLUSION: MRI results corresponded with TTE results in patients with outlet VSDs, but discordant results were observed in patients with membranous VSDs.
Assuntos
Prolapso da Valva Aórtica/diagnóstico , Ecocardiografia , Comunicação Interventricular/complicações , Imageamento por Ressonância Magnética , Prolapso da Valva Aórtica/complicações , Prolapso da Valva Aórtica/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/diagnóstico por imagem , Humanos , Lactente , Imagem Cinética por Ressonância Magnética , MasculinoRESUMO
BACKGROUND AND AIM: Aortic valve (AV) cusp prolapse and subsequent aortic insufficiency (AI) are 2 of factors leading to left ventricular (LV) enlargement and decreased LV function. Aortic valve replacement (AVR) has been the standard surgical procedure for AI. However, few data is available on the prognosis of these patients undergoing AVR procedure, especially in Chinese population. The study aims to evaluate the potential risk factors affecting the mid-term adverse outcomes after AVR. METHODS: One hundred thirty-four patients (mean age: 46.7 years old) with AV cusp prolapse and severe AI who all received surgical aortic valve replacement were recruited in our hospital between January 1, 2009 and December 30, 2017. The clinical characteristics, echocardiography parameters, as well as operative parameters were obtained. The primary endpoint included death, heart failure development, and reoperation. RESULTS: There were 14 adverse events altogether with the primary endpoint during a median follow-up of 8.6 (6-10) months. The multivariable Cox regression analysis revealed that baseline LVEDD (hazard rate, HRâ=â1.08, 95% CI: 1.01-1.15, Pâ=â.021), moderate pulmonary hypertension (HRâ=â9.36, 95% CI: 1.81-48.28, Pâ=â.008), and the time of assisted mechanical ventilation (HRâ=â1.01, 95% CI: 1.00-1.01, Pâ=â.022) were independently associated with the primary endpoint. Kaplan-Meier survival curve showed a significant worse survival free of the endpoint for patients with LVEDD≥70âmm, indexed LVEDD≥37.3âmm/m (the mean in this study), indexed LVESD≥25âmm/m or baseline LVEF <50% (all P<.05). CONCLUSION: Baseline enlarged LV dimensions, low LV function, moderate pulmonary hypertension, and prolonged assisted mechanical ventilation may predict the poor mid-term postoperative outcomes for AV cusp prolapse patients undergoing AVR procedure.
Assuntos
Prolapso da Valva Aórtica/cirurgia , Complicações Pós-Operatórias/etiologia , Prognóstico , Adulto , Prolapso da Valva Aórtica/complicações , Prolapso da Valva Aórtica/epidemiologia , China/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Modelos de Riscos Proporcionais , Fatores de Risco , Resultado do TratamentoAssuntos
Prolapso da Valva Aórtica , Comunicação Interventricular , Criança , Humanos , Prolapso da Valva Aórtica/complicações , Prolapso da Valva Aórtica/diagnóstico por imagem , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , EcocardiografiaAssuntos
Insuficiência da Valva Aórtica , Prolapso da Valva Aórtica , Procedimentos Cirúrgicos Cardíacos , Humanos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Prolapso , Prolapso da Valva Aórtica/complicações , Prolapso da Valva Aórtica/diagnóstico por imagem , Resultado do TratamentoRESUMO
OBJECTIVE: To report intermediate follow-up result of transcatheter closure of ventricular septal defect (VSD) in presence of aortic valve prolapse (AVP) with or without aortic regurgitation (AR). METHOD: This is a retrospective review of 19 patients with VSD with AVP with AR who underwent transcatheter closure in between September 2011-July 2014. Mean age was 8 years (1-16 years, standard deviation [SD] 4.08 years) and mean weight was 26.03kg (9-81.5kg, SD 16.57kg). Among them 2 had subarterial VSD, 6 had subaortic VSD and 11 had perimembranous VSD. All of them had mild AVP and 13 of them had AR (trivial or mild). Median VSD size was 4.3mm (4-6mm). Transcatheter closure was done either by retrograde technique using the Amplatzer Duct Occluder-II in 17 patients or antegrade technique using the Duct Occluder-I in 2 cases. Mean follow-up period was 18 months (12-36 months). RESULT: Immediate major complications were encountered in 2 (10.5%) cases. Significant aggravation of device related AR was seen in one case & device embolised to right pulmonary artery in another case and both of them were managed surgically. During follow up, 1 child had significant additional VSD requiring device closure. One child developed moderate AR, requiring surgery. None of the other had shown any increase in severity of AR. CONCLUSION: Device closure of VSD in presence of mild AVP and mild AR appears to be safe. Longer follow-up is necessary to draw final conclusion.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Prolapso da Valva Aórtica/cirurgia , Cateterismo Cardíaco/métodos , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal , Adolescente , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Prolapso da Valva Aórtica/complicações , Prolapso da Valva Aórtica/diagnóstico , Criança , Pré-Escolar , Feminino , Seguimentos , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
As the velocity of a fluid increases a low-pressure zone is created, this is the Venturi effect and it explains the pathogenesis of aortic valve prolapse (AVP) and aortic insufficiency (AI) that is observed in a subset of patients with a ventricular septal defect (VSD). The VSDs complicated by AI are restrictive with high velocity shunting through the VSD, creating a low-pressure zone that impacts the adjacent aortic valve cusp resulting in AVP and subsequent AI. AVP and AI are therefore acquired lesions. AI is absent at birth because the forces necessary to create the low-pressure zone within the restrictive VSD do not exist in utero. The risk of development of AI increases during childhood, peaking at 5 to 10 years of age. VSD closure eliminates the low-pressure zone that is the cause of ongoing aortic valve cusp deformity and, if performed early, prevents development of AI. Patients with a subarterial VSD and AVP should undergo surgery to prevent the development of AI because this complicates about half of subarterial VSDs with AVP and spontaneous closure is rare. Patients with perimembranous VSDs with AVP should be followed with serial echocardiography and undergo VSD closure if more than trivial AI develops.
Assuntos
Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Comunicação Interventricular/fisiopatologia , Comunicação Interventricular/cirurgia , Insuficiência da Valva Aórtica/complicações , Prolapso da Valva Aórtica/complicações , Prolapso da Valva Aórtica/fisiopatologia , Prolapso da Valva Aórtica/cirurgia , Fenômenos Biomecânicos , Procedimentos Cirúrgicos Cardíacos , Comunicação Interventricular/complicações , Hemodinâmica , Humanos , Seleção de PacientesAssuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Prolapso da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Adulto , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Prolapso da Valva Aórtica/complicações , Bioprótese , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca , Hemodinâmica/fisiologia , Humanos , Masculino , Insuficiência da Valva Mitral/etiologiaRESUMO
Abstract Introduction: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. Methods: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). Results: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. Conclusion: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.
Assuntos
Humanos , Idoso , Insuficiência da Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/complicações , Prolapso da Valva Aórtica/cirurgia , Prolapso da Valva Aórtica/complicações , Prolapso da Valva Aórtica/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Comunicação Interventricular/complicações , Prolapso , Síndrome , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Few data are available with regard to the impact of aortic cusp herniation on the evolution of aortic regurgitation (AR) in patients with a perimembranous ventricular septal defect (VSD). METHODS: One hundred and two patients with a perimembranous ventricular septal defect with right coronary cusp prolapse were divided to two groups depending on the development of aortic regurgitation. The original defect diameter, the right coronary cusp deformity index (RCCD), and the right coronary cusp imbalance index were obtained as we reported previously. RESULTS: Mild aortic regurgitation was detected in 35 patients, and moderate in three. No aortic regurgitation was observed in 64 patients. A significantly larger number of patients had noncoronary cusp prolapse and the right coronary cusp imbalance index >/=1.30 in the aortic regurgitation group than in the no regurgitation group. Relative risk and odds ratio of noncoronary cusp prolapse and the right coronary cusp imbalance index >/=1.30 for development of aortic regurgitation were 3.69 (95% CI, 0.91-15.03) and 27.90 (95.94-130.85), and 2.23 (0.83-5.98) and 4.70 (1.44-15.27), respectively. Surgical closure was performed in 29 patients. All patients with no noncoronary cusp prolapse underwent simple patch closure of the ventricular septal defect, while five patients with noncoronary cusp prolapse and aortic regurgitation underwent aortic valvuloplasty. Among these, one patient needed aortic valve replacement. CONCLUSIONS: The additional complication of noncoronary cusp prolapse is a strong risk factor for the development of aortic regurgitation in patients with a perimembranous ventricular septal defect with right coronary cusp prolapse.
Assuntos
Insuficiência da Valva Aórtica/etiologia , Prolapso da Valva Aórtica/complicações , Comunicação Interventricular/complicações , Adolescente , Adulto , Insuficiência da Valva Aórtica/diagnóstico por imagem , Prolapso da Valva Aórtica/diagnóstico por imagem , Prolapso da Valva Aórtica/cirurgia , Criança , Pré-Escolar , Ecocardiografia Doppler , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Lactente , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Prolapso da Valva Aórtica/diagnóstico por imagem , Diástole , Disfunção Ventricular Esquerda/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Prolapso da Valva Aórtica/complicações , Diagnóstico Diferencial , Diástole/fisiologia , Ecocardiografia Transesofagiana/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/complicações , Obstrução do Fluxo Ventricular Externo/complicaçõesRESUMO
From 1946 to March 1989, 92 patients (33 women and 59 men) were seen with ventricular septal defect (VSD) and audible aortic regurgitation (AR). The VSD was subcristal in 62 patients, subpulmonary in 21 and unknown in the remaining 9. The median age of onset of AR was 5.3 years. The risk of developing AR was 2.5 times greater in those with a subpulmonary VSD. The aortic valve was tricuspid in 90% and bicuspid in 10%. Prolapse was seen in 90% of those with subcristal VSD and in all with subpulmonary VSD. Pulmonary stenosis was seen in 46% of the patients with gradients ranging from 10 to 55 mm Hg. The incidence of infective endocarditis was 15 episodes/1,000 patient years. Among 20 patients followed medically, for 297 patient years, 1 died (1959) and most have been stable, including 2 followed for greater than 30 years. In the 72 patients operated on, there were 15 perioperative and 5 late deaths. Operations consisted of VSD closure alone in 7, VSD closure and valvuloplasty in 50 and VSD closure and aortic valve replacement in the other 15. Valvuloplasty was more effective in those operated on under age 10 compared to those older than 15 years (46 vs 14%). The durability of the valvuloplasty was 76% at 12 years and 51% at 18 years.