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The natural history and timing of the radical operation for subpulmonic ventricular septal defects
1Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan.
Insights
This study reviews 70 patients with subpulmonic (type I) ventricular septal defect (VSD), finding aortic regurgitation in 30%. Early repair is recommended for prolapsing valves before age 10-12 and for regurgitation unless mild.
Area of Science:
- Cardiology
- Pediatric Surgery
- Congenital Heart Disease
Background:
- Subpulmonic (type I) ventricular septal defect (VSD) is a congenital heart condition requiring surgical intervention.
- Understanding the natural history and optimal timing for VSD repair is crucial for patient outcomes.
- Aortic regurgitation is a potential complication associated with type I VSD.
Purpose of the Study:
- To investigate the natural history and optimal timing for surgical repair of subpulmonic (type I) ventricular septal defect (VSD).
- To analyze the incidence and characteristics of aortic regurgitation in patients with type I VSD.
- To establish a management strategy based on patient age, valve status, and regurgitation severity.
Main Methods:
- Retrospective review of 70 pediatric patients who underwent surgical repair for type I VSD between 1978 and 1989.
- Analysis of patient demographics, pre-operative data, surgical outcomes, and long-term follow-up.
- Correlation of aortic regurgitation severity with patient age and valve morphology using Sellers grading.
Main Results:
- Type I VSD represented 30% of all VSD repairs in the study cohort.
- Aortic regurgitation occurred in 30% of patients, with higher incidence in those over 10 years old (p<0.05).
- Median age for normal, prolapsed, and regurgitated valves differed significantly (5, 6.5, and 10 years, respectively; p<0.05). Patients with normal valves had higher shunt ratios and pulmonary artery pressures.
Conclusions:
- A management strategy for type I VSD includes regular ultrasound screening.
- Surgical repair is recommended for prolapsing valves by age 10-12 years.
- Prompt repair is advised for aortic regurgitation unless it is mild (Sellers grade two or less).
Abstract:
In order to further understand the natural history and timing of repair for subpulmonic (type I) ventricular septal defect (VSD), 70 patients who underwent radical surgery were reviewed. The patients with this type of VSD accounted for 30 per cent of a total 236 children with types I, II and III VSD who underwent repair between 1978 and 1989. The frequency of aortic regurgitation was 30 per cent, being higher in the group aged older than 10 years than in the younger group (p less than 0.05). The median ages of patients with normal, prolapsed and regurgitated valves were 5, 6.5, and 10 years, respectively, and each value exhibited significant differences (p less than 0.05). The left to right shunt ratio and systolic pulmonary artery pressure of the patients with normal valves were significantly higher than those of the patients with abnormal valves. The outcome of the patients with regurgitation varied according to Sellers grading with cases of grade two valvular deformities recovering well after the repair, while cases of grade three had deformities of grade one or two severity remaining. These results led us to establish the following strategy for patients with I-VSD: 1) a child should be regularly checked by USG; 2) a child noted as having a prolapsing valve is recommended to undergo repair by the age of 10 to 12 years; and 3) a child found to have regurgitation should undergo repair as soon as possible, unless the valve regurgitation does not become more severe than Sellers grade two.