Aortic valve repair in young patients with ventricular septal defect with aortic regurgitation- our experience
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IGINAL ARTICLE
Aortic valve repair in young patients with ventricular septal defect with aortic regurgitation- our experience Nagarajan Muthialu & Soundaravalli Balakrishnan & Rajani Sundar & Srinivasan Muralidharan
Received: 24 April 2012 / Revised: 19 July 2012 / Accepted: 5 January 2013 / Published online: 5 February 2013 # Indian Association of Cardiovascular-Thoracic Surgeons 2013
Abstract Background Perimembranous and sub arterial Ventricular Septal Defects (VSD) are associated with Aortic Regurgitation (AR) in 5 % of patients. More than mild AR needs additional valve intervention during VSD closure. Feasibility of aortic valve repair and its superior results over aortic valve replacement have been documented well. The purpose of this study is to present our initial experience in aortic valve repair in young children with aortic regurgitation. Materials and methods Fourteen out of thirty-one consecutive VSD closures had AR (45.16 %) and six of them (19.35 %) needed intervention. The median age and weight were 8.1 years and 18.7 Kg. The VSD was perimembranous in 5 and sub arterial in 1. The predominant pathology was leaflet prolapse in 5 (right coronary cusp-3, Non coronary cusp-1 and both coronary cusps-1) Results Five had successful aortic valve repair and one underwent aortic valve replacement after a failed valve repair. The technique of repair consisted of commissural placation with cusp shortening, resuspension and bicuspidisation. There were no deaths. Follow-up was 100 % complete at a median of 6 months. AR was trivial in 2, and mild in 3. All are in NYHA class I. Patient with mechanical valve N. Muthialu (*) Great Ormond Street Hospital for children, Great Ormond Street, London WC1N 3JH, UK e-mail: [email protected] S. Balakrishnan : R. Sundar Department of Anaesthesiology, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, India S. Muralidharan Department of Cardiothoracic Surgery, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
had major anticoagulation-related intra-cerebral bleed needing neurosurgical intervention. Conclusion Early intervention for VSD would possibly prevent aortic valve disease. Aortic valve repair is the procedure of choice in young patients with VSD-AR syndrome and can be performed with low risk, and the freedom from valverelated morbidity and mortality is excellent. Valve repair also avoids anticoagulation related complications. Keywords Ventricular septal defect . Aortic regurgitation . Aortic valve repair
Introduction Perimembranous and sub arterial Ventricular Septal Defects (VSD) are associated with Aortic Regurgitation (AR) in 5 % of patients [1]. The incidence of AR rises with age, and progresses further to affect the valve to irreparable state. There are various mechanisms causing this AR and one would normally expect this to either stop from progression or improve once VSD is repaired with a patch [2]. Though results of conventional VSD closure have improved remarkably over time, additional valve surgery still adds to morbidity and mortality. If
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