Ventricular septal defect associated with aortic regurgitation. Surgical considerations

Fifteen consecutive cases of ventricular septal defect (VSD) associated with aortic regurgitation (AR), observed from January 1972 to November 1980 in the Department of Cardiac Surgery of Massa Hospital were evaluated from a pathological and hemodynamic point of view and surgically treated. All patients underwent cardiac catheterization and selective aortography before and after surgical correction. The VSD was closed by Dacron patch in 10 cases and by direct suture in 5. Aortotomy was performed in 9 patients who presented moderate to severe AR; among these 7 underwent valvular repair and two prosthetic replacement. One patient died (6.6% mortality) 8 days after the operation; another developed complete atrioventricular block requiring insertion of epicardial pace-maker. Residual AR has been found in only one of the 6 patients with preoperative mild degree of AR in whom only the closure of the VSD was carried out. Residual AR is also present in 4 patients who required valvular repair, but only in one it is severe. We favor correction at preschool age on the principle that early closure of the VSD may control or prevent the progression of AR. However, in small children in whom the severity of AR may suggest the necessity of valve replacement, the operation is postponed as long as possible to avoid functional prosthetic stenosis later in life.