Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect

Abstract

Objective: To analyze the outcome of repair of aortic valve disease associated with various types of ventricular septal defect.
 Methods: In a retrospective observational study design, data of seventy-two patients of ventricular septal defect (VSD) associated with aortic valve prolapse (AVP) and aortic regurgitation (AR) who was operated in Punjab Institute of cardiology from May 2016 to April 2020 was collected. Depending on presence of AR, all patients were divided in four groups. Group-I (VSD and AVP but no AR) had fifteen patients. Only VSD was closed in this group. Group-II (VSD and Mild AR) had forty patients, only VSD was closed in this group as well. Group-III (VSD and Moderate AR) had ten patients, VSD closure and aortic valve repair was done. Group-IV (VSD and severe AR) had seven patients. Aortic valve was repaired in five patients and replaced (AVR) in two patients along with VSD closure. Associated anomalies were addressed as well.
 Results: Group-I: Twelve out of fifteen patients (80%) showed no post-operative AR. While two patients (13.3%) showed Trace AR. Single patient (6.6%) showed mild AR. There results were unchanged after mean follow up of 36 months. Group-II: Eight out of forty patients (20%) had no AR, while eight (20%) had trace AR. Twenty-three (57.5%) patients had mild AR. Single (2.5%) patient had moderate AR. After follow up of 24 months the patient with moderate AR progressed to severe AR. We are planning to do Aortic Valve Replacement (AVR) in this case. Rest of cases showed no progression of disease. Group-III: Two out of ten patients (20%) had no AR, four (40%) had trace AR, while four (40%) had mild AR. Mean follow up was 42 months (2.5 years). Neither trace nor mild AR progressed to severe or moderate AR. Group-IV: Among seven patients, five underwent repair while two had AVR. Out of five patients who underwent aortic valve repair, four patients (57.1%) were declared mild AR, while severe AR was converted to moderate AR in single patient (14.28%). Mean follow up was 18 months. The moderate AR patient has progressed to severe AR for last six months and we are planning to do AVR in this patient. Postoperative echo of patients with AVR showed adequately functioning aortic valve with AVPG mean 10 mmHg and 15 mm Hg respectively, with no residual AR.
 Conclusions: Aortic regurgitation associated with VSD is a congenital lesion with continuously active aortic valve disease resulting in significant morbidity and mortality. Early diagnosis, effective treatment and meticulous follow up decelerate and in most cases arrest the disease process.
 doi: https://doi.org/10.12669/pjms.37.3.3067
 How to cite this:Waqar T, Rizvi MFA, Nasir JA, Khan K. Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3067
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Burden of VSD associated aortic valve cusp prolapse with aortic regurgitation and the impact of early surgery on clinical outcomes in South Asia

“…Overall, the studies of Waqar et al . 4 , 11 deserve appreciation and show that mid-term outcomes are excellent in CHD patients. This reflects their surgical skills and experiences at a “high-volume” tertiary center.…”

“…VSD with aortic cusp prolapse and subsequent AR is rare (approximately 5%) in North America and Western Europe, but is more common in the Asian populations. 4,5,7,8 Kumari et al reviewed a South Asian population with VSDs over a two year period and identified AR in 23% of patients. 9 In this study, 17.9% of defects closed spontaneously, 51.6% of patients underwent surgery and in 30.5% of patients there was no indication for surgery.…”

“…In a recent edition of the Pakistan Journal of Medical Science (Pak J Med Sci), Waqar et al presented some interesting results for surgical outcomes of repair of VSD-associated aortic valve prolapse. 4 The authors studied 72 patients with VSD-associated aortic valve prolapse operated in Punjab Institute of Cardiology between 2016 and 2020 (18 patients per year). In 55 patients, AR was either absent (n=15, group I) or mild (n=40, group II).…”

“… 1 , 2 VSDs that involve the outlet septum may be associated with progressive aortic regurgitation (AR) due to prolapse of the right aortic cusp and aneurysm of the sinus of Valsalva. 4 It has been shown that up to 40% patients with VSD-associated right aortic cusp prolapse can develop AR. 5 A simple VSD may close spontaneously and in these patients survival rates are very high.…”

“…VSD with aortic cusp prolapse and subsequent AR is rare (approximately 5%) in North America and Western Europe, but is more common in the Asian populations. 4 , 5 , 7 , 8 Kumari et al . reviewed a South Asian population with VSDs over a two year period and identified AR in 23% of patients.…”