Surgery for ventricular septal defect with aortic regurgitation

Abstract

Twenty-two patients (mean age of 12.9 years) with ventricular septal defect (VSD) associated with aortic regurgitation (AR) were treated surgically. Sixteen patients had subpulmonic VSD and six had infracristal VSD. Fourteen patients with subpulmonic VSD underwent VSD closure alone. VSD was closed by pulling up the inferior rim to the pulmonary valve thus support the prolapse aortic cusp. AR improved in two and has remained stable in eleven for 0.5 to 12.7 years (mean 4.4 years). Aortic valve replacement (AVR) was necessary in an adult patient later. Plication of the aortic valve was effective in a young patient but ineffective in an adult patient. In infracristal VSD, AVR was necessary in two adult patients. In a young patient, AR improved by plication. Direct VSD closure ceased progression of AR in three patients. The long-term follow-up shows that VSD closure with our technique has been sufficient to arrest progression of AR in subpulmonic VSD. Early closure of VSD should be emphasized to prevent aortic valve prolapse and regurgitation.