Syndrome of Ventricular Septal Defect and Aortic Regurgitation — A 22-Year Review of its Management

Abstract

Introduction The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. Methods This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). Results A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. Conclusion We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.

Laubry-Pezzi Syndrome in an Adult Male Patient and Its Surgical Correction: A Case Report and Literature Review

“…Echocardiography is an essential diagnostic tool for detecting structural anomalies of the heart, but it is unreliable in providing the actual size of the VSD, especially in the presence of AR, because the proper size tends to be underestimated. The best method would still be the intraoperative measurement of the VSD defect [3], which was performed in this case and found a disparity between echocardiographic measurements. Furthermore, per-operatively, VSD was located sub arterial (subaortic-subpulmonary).…”

“…Regarding the age of the detection of AR, detection trends are mainly between the ages of 3 -8 years [7]. Furthermore, the literature reported that elderly patients with such kind of defect presented with more severe AR [3]. The findings of aortic pathology in the current case correspond to several pieces of literature that mentioned that, in the later stages of the disease presentation due to structural abnormalities in the sinus and the ascending aorta, aneurysmal dilatation of the aortic root and ascending aorta is possible [2] [8] [9].…”

“…In the treatment of AR, AVr has been an appealing alternative to AVR. Nevertheless, AVr is difficult for the elderly age group [3]. This case report describes a patient with Laubry-Pezzi syndrome and its surgical management.…”

Laubry–Pezzi syndrome: three case reports and review of the literature

“…The management of this rare syndrome still remains nonconsensual, whether it is through timing or operative techniques 3 , 6 , 17 . However, it is recommended for early closure of the VSD to prevent the occurrence or progression of aortic insufficiency 3 , 11 , 13 , 14 . Once prolapse and regurgitation of the aortic valves have set in, surgery to close the VSD alone without intervention on the aortic valve may not be sufficient, hence the importance of early closure of the VSD.…”

“…The generally favorable postoperative course can be marred by complications. They occur more frequently in the presence of certain factors, such as the size of the VSD, the severity of the AR, the age at the time of the operation, and the number of prolapsed cusps 14 , 21 .…”