Doubly committed subarterial ventricular septal defect: A risk factor for aortic distortion in patients considered for percutaneous pulmonary valve implantation?

Abstract

Percutaneous pulmonary valve implantation has gradually become the first line strategy for re-intervention for right ventricular outflow tract dysfunction during long-term follow-up after congenital cardiac surgery in many centers. We describe a case of a patient with double outlet right ventricle (Fallot's type) with a doubly committed subarterial ventricular septal defect, where the unique anatomy precluded percutaneous pulmonary valve implantation. © 2016 Wiley Periodicals, Inc.

Aortic valve prolapse misdiagnosed as aortic sinus aneurysm in patients with ventricular septal defect. Analysis of the echocardiographic findings

“…In all 9 patients, the size of doubly committed VSD appeared smaller when measured by TTE than in the surgical findings due to the prolapsed coronary leaflets were tethered to the VSD margin, overlying part of the VSD and thus reducing its apparent size 10. In addition, the jet of the VSD was not parallel to the ultrasound beam 11.…”

“…The introduction of echocardiography has made it possible to noninvasively diagnose the location and presence of the VSD and aortic valve deformity 8. Aortic sinus aneurysm is often associated with doubly committed VSD,9 although we observed that the echocardiographic criteria for diagnosis of aortic sinus aneurysm include the following a) the root of the aneurysm is above the aortic annulus, b) the aneurysm is saccular, c) continuous turbulence and high velocities can be detected by continuous-wave Doppler distal to the area of rupture, and d) color flow shows mosaic turbulence across the ruptured aneurysm in real time 10. Using TTE, we occasionally misdiagnose aortic valve prolapse as aortic sinus aneurysm in patients with doubly committed VSD.…”

“…In all 9 patients, the pronounced distortion and translocation of the aortic annulus resulting from the lack of anatomical support due to the large doubly committed VSD made it difficult to judge the exact location of the root of the aneurysm-like protrusions using the 2–dimensional TTE. Valve excrescences can always form on the surface of the aortic valves as a result of infective endocarditis; they can appear not only as nodular masses ( Figure 1 ), but also as long strips ( Figure 2 ) 9,10. These excrescences float around the VSD, covering the aortic annulus, making it more difficult to demarcate the roots of aneurysm-like protrusions.…”