Doubly committed Subarterial Ventricular Septal defect repair: An experience of 51 cases
Tariq Waqar1, Muhammad Farhan Ali Rizvi2, Ahmad Raza Baig3
1Tariq Waqar, FCPS, FRCS. Associate Professor of Pediatric Cardiac Surgery, CPE Institute of Cardiology, Multan, Pakistan.
Insights
Early closure of doubly committed subarterial (DCSA) ventricular septal defect repairs effectively manages aortic valve issues. This surgical approach halts disease progression in patients with VSD and related aortic conditions.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Doubly committed subarterial (DCSA) ventricular septal defects (VSD) are a subset of congenital heart abnormalities.
- These defects can be associated with aortic valve abnormalities and regurgitation, impacting surgical outcomes.
- Understanding the surgical results of DCSA VSD repair is crucial for optimizing patient management.
Purpose of the Study:
- To evaluate the surgical outcomes of DCSA VSD repair.
- To assess the impact of aortic valve status on surgical results and long-term prognosis.
- To determine if early intervention can prevent disease progression.
Main Methods:
- Retrospective review of 51 patients with DCSA VSD undergoing surgical repair between January 2012 and June 2017.
- Patients were categorized into four groups based on aortic structural integrity and valve regurgitation severity.
- Surgical management of the aortic valve was tailored to the specific group and findings.
Main Results:
- No aortic regurgitation was observed in Group A (no aortic abnormalities) post-operatively or during follow-up.
- Aortic valve was not addressed in Group B (cusp prolapse without regurgitation) and showed no post-operative regurgitation.
- Patients in Group C (mild regurgitation) also showed no disease progression without aortic valve intervention.
- Significant improvement in aortic regurgitation was achieved in Group D (moderate to severe regurgitation) with valve repair or replacement.
Conclusions:
- Early surgical closure of DCSA VSD is effective in preventing further complications.
- Appropriate management of associated aortic valve disease during VSD repair is essential.
- Timely intervention halts the progression of disease related to DCSA VSD and aortic valve issues.
Objective:
To review the surgical outcome of doubly committed subarterial (DCSA) ventricular septal defect repair.
Method:
Data of 51 patients of doubly committed sub arterial Ventricular septal defect from January 2012 to June 2017 that were referred to Chaudhary Pervaiz Elahi institute of Cardiology Multan was retrospectively reviewed using electronic database. All patients were operated by first author. In our study, we segregated patients into four main groups depending on presence or absence of aortic structural defect and degree of aortic valve regurgitation. Group-A comprised of nineteen (37%) patients who neither had aortic structural nor functional abnormality while Group-B had six (11.7%) patients, having aortic valve cusp prolapse without aortic regurgitation. Group-C and Group-D consists of seventeen (33.3%) and nine (17.6%) patients respectively depending upon degree of aortic regurgitation. Furthermore, six (11.7%) patients among these 51 had associated defects as well.
Results:
Group-A patients had no aortic valve regurgitation post operatively and at follow up of 22.6 months (1.8 years) as well. In Group-B, aortic valve was not addressed and aortic regurgitation was also not present post operatively or on follow up of 33.6 months (2.8 years). Similarly, in Group-C aortic valve was not addressed, these patients also did not show progression of disease on regular follow up of 18 months (1.5 year). While, in Group-D, eight patients underwent aortic valve repair and one patient had aortic valve replacement. Aortic regurgitation improved significantly in all patients of this group and remained unchanged on follow up of 22.7 months (1.8 years).
Conclusion:
Early closure of doubly committed subarterial ventricular septal defect with appropriate management of aortic valve disease can halt the process of disease progression.
