Summary
The records of 153 patients with doubly committed subarterial ventricular septal defect (DCVSD) who underwent intracardiac repair were analyzed to evaluate factors responsible for aortic valve leaflet deformity. The patients were divided into two groups according to their echocardiographic and angiographic features as well as anatomic findings at operation: DCVSD without (17/153, 11.1%) and with arterial valve offsetting (136/153, 88.9%). Aortic regurgitation (AR) was much more prevalent in the patients with (50.0%) than in those without leaflet deformity (2.2%,P < 0.01). Arterial valve offsetting is one of the major contributing factors to the development of leaflet deformity, accounting for 5.9% in the patients without offsetting and 46.3% in those with offsetting (P < 0.01). Among the patients with arterial valve offsetting, the pulmonary-to-systemic pressure ratio was significantly higher (P < 0.01) in the patients without (0.76 ± 0.14) than in those with leaflet deformity (0.36 ± 0.12), suggesting that pulmonary hypertension might prevent the aortic valve leaflet from prolapsing in DCVSD. In addition, increased severity of aortic valve leaflet deformity and subsequent AR were observed with increasing age. These results suggest that aging and the presence of arterial valve offsetting as well as the absence of pulmonary hypertension might be factors responsible for aortic valve leaflet deformity and subsequent AR in DCVSD. The anatomic and hemodynamic features in DCVSD have a great impact on the development of aortic valve leaflet deformity and subsequent AR.
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Ando M, Takao A (1986) Pathological anatomy of ventricular septal defect associated with aortic valve prolapse and regurgitation. Heart Vessels 2:117–126
Griffin M, Anderson R, McCartney F (1988) Doubly committed subarterial ventricular defect: new morphological criteria with echocardiographic and angiocardiographic correlation. Br Heart J 59:474–479
Becker AE, Anderson RH (1985) Classification of ventricular septal defects — a matter of precision. Heart Vessels 2:120–121
Karpawich PP, Duff DF, Mullius CE, Cooley DA, McNamara DG (1981) Ventricular septal defect with associated aortic valve insufficiency: progression of insufficiency and operative results in young children. J Thorac Cardiovasc Surg 82:182–189
Van Praagh R, McNamara JJ (1968) Anatomic types of ventricular septal defect with aortic insufficiency. Diagnostic and surgical considerations. Am Heart J 75:604–619
Lue HC, Sung TC, Hou SH, Wu MH, Cheng SJ, Chu SH, Hung CR (1986) Ventricular septal defect in Chinese with aortic valve prolapse and aortic regurgitation. Heart Vessels 2:111–116
de Leval MR, Pozzi M, Starnes V, Sullivan ID, Stark J, Sommerville J, Anderson RH, Deanfield JE (1988) Surgical management of doubly committed subarterial ventricular septal defects. Circulation 78 (suppl III):III40-III46
Momma K, Toyama K, Takao A (1984) Natural history of subarterial infundibular ventricular septal defect. Am Heart J 108:1312–1317
Tohyama K, Satomi G, Momma K (1997) Aortic valve prolapse and aortic regurgitation associated with subpulmonic ventricular septal defect. Am J Cardiol 79:1285–1289
Keane JF, Plauth WH, Nadas AS (1977) Ventricular septal defect with aortic regurgitation. Circulation 56 (suppl I):I72–77
Tatsuno K, Ando M, Takao A, Hatsune K, Konno S (1975) Diagnostic importance of aortography in conal ventricular septal defect. Am Heart J 89:171–177
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Kobayashi, J., Koike, K., Senzaki, H. et al. Correlation of anatomic and hemodynamic features with aortic valve leaflet deformity in doubly committed subarterial ventricular septal defect. Heart Vessels 14, 240–245 (1999). https://doi.org/10.1007/BF01747853
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DOI: https://doi.org/10.1007/BF01747853