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David TE. Almost All Incompetent BAV Should Be Repaired. Semin Thorac Cardiovasc Surg 2019; 31:661-663. [PMID: 30980931 DOI: 10.1053/j.semtcvs.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/18/2019] [Indexed: 11/11/2022]
Abstract
The short answer to this topic is "No, most incompetent bicuspid aortic valve should not be repaired." Aortic valve repair certainly plays an important role in the management of incompetent bicuspid aortic valve of young patients, and the selection criteria are like those for incompetent tricuspid aortic valve. The tissue that makes the cusps should normal or have minor abnormalities easily corrected by surgery such as plication of the free margin. In addition, the anatomic orientation of the conjoint and the normal cusps should be approximately at 180°. If the root is dilated, reimplantation of the aortic valve is likely the most reproducible approach, and if the root is not dilated but the annulus is, a subannular annuloplasty and correction of the cusp prolapse is adequate. Most patients with incompetent bicuspid aortic valve have malformed, fibrotic and calcified cusps and replacement with either pulmonary autograft or a mechanical aortic valve in young patients and a bioprosthetic aortic valve are likely to provide better long-term outcomes than aortic valve repair.
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Affiliation(s)
- Tirone E David
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
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Abralov K, Alimov A. Short-Term Results of Sinus of Valsalva Aneurysm Repair. World J Pediatr Congenit Heart Surg 2017; 8:13-17. [PMID: 28033075 DOI: 10.1177/2150135116673809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We retrospectively analyzed 65 patients who underwent surgical repair of sinus of Valsalva aneurysm over the last 27 years. METHODS From January 1, 1988, to October 1, 2015, a total of 65 patients with sinus of Valsalva aneurysm underwent surgical repair in our hospital. There were 41 males (63%) and 24 females (37%), and their age ranged from 5 to 50 years (mean 23 ± 10 years, median 21 years). Out of the 65 patients, 45 (69%) had ruptured sinus of Valsalva aneurysm, 46 (70%) had a ventricular septal defect, and 22 (34%) had aortic valve insufficiency. The ruptured sinus of Valsalva was repaired with patch in 12 cases and direct suturing in 33 cases. The aortic valve was replaced in five patients and the aortic root was replaced in five patients. RESULTS Sixty patients (92%) survived the 30-day operative interval. At one year follow-up, only two patients had complications: infective endocarditis and sepsis, which lead to septic shock (n = 1) and paraprosthetic leakage and mitral valve regurgitation (n = 1). All the other patients were well and in New York Heart Association functional class I or II. CONCLUSION In this relatively high-risk population, repair of SVA can be achieved with satisfactory early results.
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Affiliation(s)
- Khakimjon Abralov
- 1 Department of Congenital Heart Disease at JSC "Republican Specialized Center of Surgery named after academician V. Vakhidov", Tashkent, Uzbekistan
| | - Amonjon Alimov
- 1 Department of Congenital Heart Disease at JSC "Republican Specialized Center of Surgery named after academician V. Vakhidov", Tashkent, Uzbekistan
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Técnicas de preservación de válvula aórtica. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2014.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Žáček P, Vojáček J, Dominik J, Harrer J. A history of the surgical treatment of aortic regurgitation. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Técnicas de reparación valvular aórtica. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Technische Durchführung der Aortenklappenrekonstruktion. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-013-1070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Oka T, Okita Y, Matsumori M, Okada K, Minami H, Munakata H, Inoue T, Tanaka A, Sakamoto T, Omura A, Nomura T. Aortic regurgitation after valve-sparing aortic root replacement: modes of failure. Ann Thorac Surg 2011; 92:1639-44. [PMID: 21945227 DOI: 10.1016/j.athoracsur.2011.06.080] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 06/19/2011] [Accepted: 06/22/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Despite the positive clinical results of valve-sparing aortic root replacement, little is known about the causes of reoperations and the modes of failure. METHODS From October 1999 to June 2010, 101 patients underwent valve-sparing aortic root replacement using the David reimplantation technique. The definition of aortic root repair failure included the following: (1) intraoperative conversion to the Bentall procedure; (2) reoperation performed because of aortic regurgitation; and (3) aortic regurgitation equal to or greater than a moderate degree at the follow-up. Sixteen patients were considered to have repair failure. Three patients required intraoperative conversion to valve replacement, 3 required reoperation within 3 months, and another 8 required reoperation during postoperative follow-up. At initial surgery 5 patients had moderate to severe aortic regurgitation, 6 patients had acute aortic dissections, 3 had Marfan syndrome, 2 had status post Ross operations, 3 had bicuspid aortic valves, and 1 had aortitis. Five patients had undergone cusp repair, including Arantius plication in 3 and plication at the commissure in 2. RESULTS The causes of early failure in 6 patients included cusp perforation (3), cusp prolapse (3), and severe hemolysis (1). The causes of late failure in 10 patients included cusp prolapse (4), commissure dehiscence (3), torn cusp (2), and cusp retraction (1). Patients had valve replacements at a mean of 23 ± 20.9 months after reimplantation and survived. CONCLUSIONS Causes of early failure after valve-sparing root replacement included technical failure, cusp lesions, and steep learning curve. Late failure was caused by aortic root wall degeneration due to gelatin-resorcin-formalin glue, cusp degeneration, or progression of cusp prolapse.
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Affiliation(s)
- Takanori Oka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Cusp Prolapse Repair in Trileaflet Aortic Valves: Free Margin Plication and Free Margin Resuspension Techniques. Ann Thorac Surg 2009; 88:455-61; discussion 461. [DOI: 10.1016/j.athoracsur.2009.04.064] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 04/15/2009] [Accepted: 04/16/2009] [Indexed: 11/19/2022]
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9
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Aicher D, Langer F, Adam O, Tscholl D, Lausberg H, Schäfers HJ. Cusp repair in aortic valve reconstruction: Does the technique affect stability? J Thorac Cardiovasc Surg 2007; 134:1533-8; discussion 1538-9. [DOI: 10.1016/j.jtcvs.2007.08.023] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 08/09/2007] [Accepted: 08/27/2007] [Indexed: 01/17/2023]
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Schäfers HJ. Reconstruction of bicuspid aortic valves. Surgical tool or toy? ZEITSCHRIFT FUR KARDIOLOGIE 2005; 94:431-3. [PMID: 15997342 DOI: 10.1007/s00392-005-0242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Accepted: 01/21/2005] [Indexed: 05/03/2023]
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Carr JA, Savage EB. Aortic valve repair for aortic insufficiency in adults: a contemporary review and comparison with replacement techniques. Eur J Cardiothorac Surg 2004; 25:6-15. [PMID: 14690726 DOI: 10.1016/j.ejcts.2003.09.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In evaluating the goal of aortic valve preservation, there have been 11 reports of large series of aortic valve repair for aortic insufficiency in adults published in recent years. We sought to analyze the validity of these methods and compare them to published results for bioprosthetic valves, pulmonary autografts, and aortic homografts. From 1990 to 2002, 761 adult aortic valve repairs were reported. Perioperative morbidity ranged from 3.6 to 23% (mean 14%), early mortality 0-8% (mean 3.6%), and late mortality 0-8% (mean 2.8%). The 5- and 10-year freedom from reoperation rates for repair were 89 and 64%. Although early results are good, long-term analysis suggests that, as a group, the durability of repair is unclear. Patients with rheumatic valvular disease appear to have an increased incidence of recurrence and repair failure. Although suture line dehiscence continues to be both an early and late complication with repair, the long-term morbidity and mortality is low and valve repair may be an option in carefully selected patients. However, the inability to break down the results by techniques does not allow for a definitive conclusion. Further subanalysis is necessary as larger series are reported. Proponents must attempt to separate successful from unsuccessful techniques. Aortic valve repair is a technique in evolution.
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Affiliation(s)
- John Alfred Carr
- Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, 1653 West Congress Parkway, Chicago, IL 60612, USA
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Elgamal MA, Hakimi M, Lyons JM, Walters HL. Risk factors for failure of aortic valvuloplasty in aortic insufficiency with ventricular septal defect. Ann Thorac Surg 1999; 68:1350-5. [PMID: 10543505 DOI: 10.1016/s0003-4975(99)00970-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- M A Elgamal
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, USA
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Yacoub MH, Khan H, Stavri G, Shinebourne E, Radley-Smith R. Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of Valsalva, and ventricular septal defect. J Thorac Cardiovasc Surg 1997; 113:253-60; discussion 261. [PMID: 9040618 DOI: 10.1016/s0022-5223(97)70321-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although the syndrome of ventricular septal defect and aortic regurgitation was described a long time ago, there is still no agreement about the anatomic and functional components of the syndrome and the optimal methods of management. OBJECTIVE Our objective was to describe a new simple technique of anatomic correction of all the components of the syndrome, based on redefining the salient anatomic and functional features of the syndrome. METHODS Anatomic correction of the syndrome is achieved through a transaortic approach with the placement of a series of pledget-supported mattress sutures using autogenous pericardium. The sutures are used to close the ventricular septal defect, plicate the aortic sinus, and correct the outward and downward displacement of the anulus of the aortic valve. The technique is designed to correct all the anatomic functional components including severe aortic regurgitation when present. RESULTS Between 1972 and 1996, 46 patients with this syndrome underwent surgical treatment. The current technique was used in most of the patients operated on before 1981 and in all patients since that date. There were no early or late deaths during a follow-up period varying from 3 months to 24 years (mean 8.4 years). Aortic regurgitation was abolished in 16 and improved in the remaining patients, The hemodynamic results have been maintained except in five patients operated on early in the series, in whom additional procedures on the cusps were performed. CONCLUSIONS Anatomic correction of all the components of the syndrome of prolapsing right coronary cusp, dilatation of the sinus of Valsalva, and ventricular septal defect, can be achieved by a very simple technique. This technique can be applied in young children and prevents progression and secondary changes. Early correction in all patients with this syndrome is warranted.
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Affiliation(s)
- M H Yacoub
- Imperial College of Science, Technology, and Medicine, Harefield Hospital, Middlesex, United Kingdom
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Haydar HS, He GW, Hovaguimian H, McIrvin DM, King DH, Starr A. Valve repair for aortic insufficiency: surgical classification and techniques. Eur J Cardiothorac Surg 1997; 11:258-65. [PMID: 9080152 DOI: 10.1016/s1010-7940(96)01014-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Valve repair for aortic insufficiency may provide an alternative to aortic valve replacement in selected patients. This repair could be an attempt at permanent correction or palliation to allow the aortic annulus to grow and avoid the use of anticoagulation. Based upon a five-year experience, we proposed a classification according to valvular anatomy which could be a guide to patient and procedure selection. METHODS Between September 1989 and February 1995, 44 consecutive patients underwent aortic valvuloplasty for aortic incompetence at our institution. Patients' ages ranged from 19 months to 76 years with a mean of 33 years. The etiology of aortic incompetence was congenital in 30 patients, degenerative in 7 patients, rheumatic in 5 patients, and infective endocarditis in 2. Aortic valve lesions were classified into three different types: type I, aortic annular dilation (8 patients); type II, excessive aortic leaflet tissue (12 patients); and type III, restricted leaflet motion with or without deficient leaflet tissue (24 patients). Type I needed commissural plication in 7 patients; and aortic annuloplasty, which was simple in 6 patients, and pericardial-augmented in 2. Type II necessitated midleaflet excision in 11 patients and leaflet plication in 7. Type III required leaflet extension in 19 patients, leaflet replacement in 1 patient, aortic valve commissurotomy in 13 patients augmentation commissurorrhaphy in 2, leaflet shaving in 4, and repair of leaflet perforation in 2. RESULTS Postoperative echocardiography revealed a significant decrease in the degree of aortic incompetence. Mean follow-up was 2.6 +/- 1.4 years. There was no mortality. Patients improved as is evident by NYHA functional class postoperatively. Eight of the first 13 patients (18%) needed reoperation. Three of these reoperations were bail-out procedures, and 3 patients (7%) who underwent the leaflet extension technique were reoperated upon 19 months to 3 years later. Presently, 23 patients are without anticoagulation, 11 take aspirin and 2 receive coumadin for combined mitral procedures. CONCLUSIONS Aortic valve repair provides a low risk option with satisfactory intermediate-term results for the treatment of aortic insufficiency in appropriately selected patients. Patient and procedure selection may be based upon the echocardiographic anatomy of the aortic valve, and a comparative risk benefit appraisal with valve replacement.
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Affiliation(s)
- H S Haydar
- Albert Starr Academic Center for Cardiac Surgery, Portland, Oregon, USA.
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Fraser CD, Wang N, Mee RB, Lytle BW, McCarthy PM, Sapp SK, Rosenkranz ER, Cosgrove DM. Repair of insufficient bicuspid aortic valves. Ann Thorac Surg 1994; 58:386-90. [PMID: 8067836 DOI: 10.1016/0003-4975(94)92212-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A technique for the repair of bicuspid aortic valves that includes resection of the flail segment of the prolapsing leaflet, annuloplasty, and resection of the raphe, when present, has been reported. To assess the efficacy of this technique in the repair of insufficient bicuspid aortic valves, the results in 72 consecutive patients were assessed. The mean age of the patients was 39 +/- 11 years; 94% were male. Fifty-six patients (78%) underwent isolated aortic valve repair, 9 (12.5%) underwent aortic and mitral valve repair, and 7 (9.7%) had other associated procedures. All patients underwent leaflet resection, including 35 (48%) at the raphe. The mean aortic occlusion time was 39 +/- 12 minutes. There were no operative deaths. The severity of aortic insufficiency, as assessed by Doppler echocardiography (graded from 0 to 4) preoperatively and intraoperatively and at late follow-up, was 3.6 +/- 0.6, 0.4 +/- 0.4, and 0.9 +/- 0.8, respectively, with a p value of < 0.0001 for the latter two values versus the preoperative one. There have been no postoperative deaths. Patients did not receive anticoagulation treatment and there were no strokes or episodes of endocarditis. Six patients have required reoperation; 3 underwent repeat repair. The Kaplan-Meier freedom from aortic valve reoperation probabilities at 12 and 24 months were 94% and 89.5%, respectively. We conclude that valvuloplasty for insufficient bicuspid aortic valves is technically safe, is associated with a low incidence of recurrent insufficiency, and has been associated with no other valve-related complications.
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Affiliation(s)
- C D Fraser
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195
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Chang CH, Lee MC, Shieh MJ. Surgical treatment of supracristal type of ventricular septal defect. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1988; 22:221-5. [PMID: 3227324 DOI: 10.3109/14017438809106066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Surgically treated ventricular septal defect (VSD) was of supracristal type in 120 of 389 Chinese patients; 93 of the 120 were younger than 15 years. Concomitant aortic anomalies were present in 58 of the patients (regurgitation in 23 and cusp prolapse in 35). Corresponding figures among the 93 patients of the under-15 group were 40 (9 + 31). Direct suture or patch closure of the supracristal VSD and replacement or plication of anomalous aortic valves were the methods used. The results of direct closure were equal to those of patch closure. One patient died of subacute bacterial endocarditis, which had been present preoperatively. There were no other deaths. The postoperative observation period was 6 months to 7 years. As the incidence of associated valvulopathy increases with patient age, early operation for supracristal VSD, regardless of shunt volume, is advocated.
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Affiliation(s)
- C H Chang
- Department of Thoracocardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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Kusuhara K, Miki S, Ueda Y, Ohkita Y, Tahata T, Komeda M. Usefulness of electromagnetic flowmetry in intraoperative evaluation of aortic regurgitation associated with ventricular septal defect. Am J Cardiol 1987; 59:1152-5. [PMID: 2953228 DOI: 10.1016/0002-9149(87)90865-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In 38 patients with aortic regurgitation (AR) associated with ventricular septal defect (VSD), indications for aortic valvuloplasty (AVP) or aortic valve replacement (AVR) were investigated by assessing AR ratio, which was measured by electromagnetic flowmetry of the ascending aorta during the operation. Residual AR was evaluated by auscultation postoperatively. Patients were assigned to group A if they underwent VSD closure alone and to group B if they underwent AVP in addition to VSD closure; patients who had no postoperative AR were assigned to group I and those with persistence of AR to group II. Thus, the patients were separated into 4 subgroups; A-I (9 patients), A-II (5 patients), B-I (20 patients) and B-II (4 patients). In subgroup A-I, mean AR ratio decreased from 9% to 7% postoperatively, in A-II from 19% to 16% (p less than 0.1), in B-I from 36% to 9% (p less than 0.01) and in B-II from 44% to 20% (p less than 0.05). An AR ratio of more than 25% should be regarded as an absolute indication for AVP or AVR. If the AR ratio is between 20 and 25%, the indication of AVP is determined by inspection of the aortic valve. A good correlation was found between AR ratio and the AR rate determined by the aortic angiographic findings (Sellers classification): grade I AR corresponded to an AR ratio of 5 to 15%, grade II to 20 to 35%, grade III to 25 to 50% and grade IV to 45% or higher (r = 0.87, p less than 0.01).
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Karpawich PP, Duff DF, Mullins CE, Cooley DA, McNamara DG. Ventricular septal defect with associated aortic valve insufficiency. J Thorac Cardiovasc Surg 1981. [DOI: 10.1016/s0022-5223(19)39352-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tatsuno K, Ando M, Takao A, Hatsune K, Konno S. Diagnostic importance of aortography in conal ventricular-septal defect. Am Heart J 1975; 89:171-7. [PMID: 1114944 DOI: 10.1016/0002-8703(75)90042-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Chung KJ, Manning JA. Ventricular septal defect associated with aortic insufficiency: medical and surgical management. Am Heart J 1974; 87:435-8. [PMID: 4274050 DOI: 10.1016/0002-8703(74)90167-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sanfelippo PM, DuShane JW, McGoon DC, Danielson GK. Ventricular septal defect and aortic insufficiency: surgical considerations and results of operation. Ann Thorac Surg 1974; 17:213-22. [PMID: 4813124 DOI: 10.1016/s0003-4975(10)65638-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Dimich I, Steinfeld L, Litwak RS, Park S, Silvers N. Subpulmonic ventricular septal defect associated with aortic insufficiency. Am J Cardiol 1973; 32:325-8. [PMID: 4725587 DOI: 10.1016/s0002-9149(73)80141-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kawashima Y, Danno M, Shimizu Y, Matsuda H, Miyamoto T. Ventricular septal defect associated with aortic insufficiency: anatomic classification and method of operation. Circulation 1973; 47:1057-64. [PMID: 4705572 DOI: 10.1161/01.cir.47.5.1057] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Thirty-five consecutive patients with ventricular septal defect (VSD) associated with aortic insufficiency (AI) who underwent corrective surgery are presented. There were seven operative and three late deaths among the patients operated upon before 1968. No death, however, was encountered among the most recent 18 consecutive patients. The VSD was closed directly in 14 patients and with a Teflon patch in 21. The aortic valve was repaired in 16 patients, replaced in eight, and no interference was indicated in 11.
They were classified from the surgical viewpoint according to the location of the VSD, the anatomic type of the right ventricular outflow tract, and the severity of the aortic herniation as follows: type Ia, supracristal VSD and AI without aortic cusp herniation; type lb, supracristal VSD and AI with aortic cusp herniation and conal muscular rim beneath the pulmonic valve; type Ic, supracristal VSD and AI with aortic cusp herniation without conal muscular rim beneath the pulmonic valve; type IIa, infracristal VSD and AI without aortic cusp herniation; type IIb, infracristal VSD and AI with aortic cusp herniation; type III, infracristal VSD and AI with infundibular pulmonic stenosis (PS); type IV, supracristal VSD and AI with infundibular PS.
In type Ia and IIa, VSD was closed directly and the aortic valve was replaced. In most of type Ib, VSD was closed directly and no direct procedure was performed upon the aortic valve. In most of type Ic, VSD was closed with a Teflon patch and the aortic valve was repaired. In type IIb, VSD was closed with a Teflon patch and the procedure upon the aortic valve was not uniform. In type III, VSD was closed with a Teflon patch and the aortic valve was repaired in most of them. In type IV, VSD was closed with a Teflon patch and no direct procedure was performed upon the aortic valve.
The basic policy for repair of this association of anomalies is selected according to the above mentioned anatomic classification.
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Spencer FC, Doyle EF, Danilowicz DA, Bahnson HT, Weldon CS. Long-term evaluation of aortic valvuloplasty for aortic insufficiency and ventricular septal defect. J Thorac Cardiovasc Surg 1973. [DOI: 10.1016/s0022-5223(19)40819-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Murphy DA, Poirier N. A technique of aortic valvuloplasty for aortic insufficiency associated with ventricular septal defect. J Thorac Cardiovasc Surg 1972. [DOI: 10.1016/s0022-5223(19)40854-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Glasser SP, Cheitlin MD, McCarty RJ, Haas JH, Hall RJ, Mullins CE. Thirty-two cases of interventricular septal defect and aortic insufficiency. Clinical, hemodynamic and surgical features. Am J Med 1972; 53:473-80. [PMID: 5076622 DOI: 10.1016/0002-9343(72)90143-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Andersen HK, Lomholt P. Ventricular septal defect and aortic insufficiency. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1972; 6:57-67. [PMID: 5014005 DOI: 10.3109/14017437209134291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Treasure RL, Hopeman AR, Jahnke EJ, Green DC, Czarnecki SW. Ventricular septal defect with aortic insufficiency. Ann Thorac Surg 1971; 12:411-8. [PMID: 5111295 DOI: 10.1016/s0003-4975(10)65143-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Surgical considerations in the treatment of ventricular septal defect associated with aortic valvular incompetence. J Thorac Cardiovasc Surg 1969. [DOI: 10.1016/s0022-5223(19)42731-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Van Praagh R, McNamara JJ. Anatomic types of ventricular septal defect with aortic insufficiency. Diagnostic and surgical considerations. Am Heart J 1968; 75:604-19. [PMID: 5645988 DOI: 10.1016/0002-8703(68)90321-9] [Citation(s) in RCA: 135] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Sakakibara S, Konno S. Congenital aneurysm of the sinus of Valsalva associated with ventricular septal defect. Anatomical aspects. Am Heart J 1968; 75:595-603. [PMID: 5645987 DOI: 10.1016/0002-8703(68)90320-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Plauth WH, Braunwald E, Rockoff SD, Mason DT, Morrow AG. Ventricular septal defect and aortic regurgitation: clinical, hemodynamic and surgical considerations. Am J Med 1965; 39:552-67. [PMID: 5833044 DOI: 10.1016/0002-9343(65)90079-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
Thirty-four patients with ventricular septal defect and aortic regurgitation, representing less than 5 per cent of our patients with ventricular septal defect, are discussed.
A loud, systolic murmur, characteristic of ventricular septal defect, is noted during infancy, whereas evidences of aortic regurgitation (protodiastolic murmur and wide pulse pressure) does not usually appear until sometime between 2 and 10 years of age.
Clinical and catheterization data indicate that the principal hemodynamic load is aortic regurgitation, whereas the ventricular septal defect does not usually result in a large pulmonary blood flow or high pulmonary arterial pressure. In about 50 per cent of the patients, a significant pressure gradient across the right ventricular outflow tract exists.
Detailed pathologic studies indicate that the ventricular septal defects are high and anterior and encroach to a greater or lesser degree on the membranous bulbar septum. The right coronary cusp is the one most severely involved, and, by its prolapse, causes aortic regurgitation; the noncoronary cusp is always less severely affected. The anatomic basis of the pressure gradient observed across the right ventricular outflow tract is not always clear.
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MUSTARD WT. Surgery for ventricular septal defects in infants and children. Am J Surg 1964; 107:480-5. [PMID: 14129325 DOI: 10.1016/0002-9610(64)90218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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