HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mohamed-Adel Elgamal Henry L. Walters, III Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Elgamal, M.-A. Articles by Walters, H. L. Search for Related Content PubMed PubMed Citation Articles by Elgamal, M.-A. Articles by Walters, H. L., III

Ann Thorac Surg 1999;68:1350-1355
© 1999 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Risk factors for failure of aortic valvuloplasty in aortic insufficiency with ventricular septal defect

^a Department of Cardiovascular Surgery, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA

Address reprint requests to Dr Walters, Department of Cardiovascular Surgery, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201
e-mail: hwalters{at}dmc.org

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

Background. Aortic insufficiency (AI) associated with ventricular septal defect (VSD) is often repaired using a modification of Trusler’s aortic valvuloplasty technique. The purpose of this study was to identify the risk factors for failure of aortic valve (AV) repair in patients who underwent repair of associated VSD.

Methods. A univariate analysis was performed in this retrospective study to identify the possible risk factors for failure of the repair resulting in the need for AV replacement (AVR).

Results. The study included 24 patients, 15 (62%) boys and 9 (38%) girls, with a mean age of 9.1 ± 1.2 (SEM) years. The VSD was perimembranous in 15 (62%) and subarterial in 9 (38%). The prolapsed aortic cusp was the right in 13 (54%), the noncoronary in 6 (25%), and both in 5 (21%). Plication was performed at one end of the free edge of the prolapsed cusp(s) in 12 (50%) and at more than one end in 12 (50%) of the patients. The VSD was closed by use of a patch in 21 (88%) and by direct suture closure in 3 (12%). At the mean follow up of 7.3 ± 1.3 years, the degree of AI was none in 6 (25%), trivial in 5 (21%), mild in 9 (38%), moderate in 1 (4%), and severe in 3 (12%). The 15-year actuarial freedom from reoperation was 81% ± 19% (95% confidence limit). By univariate analysis, the possible risk factors for AV repair failure were the degree of AI at hospital discharge (p = 0.004), direct closure of the VSD (p = 0.061), smaller size of the VSD (p = 0.081), and plication of more than one end of the prolapsed cusp(s) (p = 0.095).

Conclusions. Trusler’s AV repair is an effective and durable technique for the surgical treatment of patients with VSD-AI syndrome. The adequacy of the initial repair is the most important determinant of the long-term results.

This article has been cited by other articles:

				S.-N. Chiu, J.-K. Wang, M.-T. Lin, E.-T. Wu, F. L. Lu, C.-I Chang, Y.-S. Chen, I.-S. Chiu, H.-C. Lue, and M.-H. Wu Aortic Valve Prolapse Associated With Outlet-Type Ventricular Septal Defect Ann. Thorac. Surg., April 1, 2005; 79(4): 1366 - 1371. [Abstract] [Full Text] [PDF]

				C. Rergkliang, V. Chittithavorn, A. Chetpaophan, and P. Vasinanukorn Surgery for Aortic Insufficiency Associated with Ventricular Septal Defect Asian Cardiovasc Thorac Ann, March 1, 2005; 13(1): 61 - 64. [Abstract] [Full Text] [PDF]

				Y.-f. Cheung, C. S.W. Chiu, T.-c. Yung, and A. K.T. Chau Impact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defect Ann. Thorac. Surg., February 1, 2002; 73(2): 622 - 627. [Abstract] [Full Text] [PDF]