Frequency and operative correction of aortic insufficiency associated with ventricular septal defect

Frequency and surgical results of aortic cusp prolapse and aortic regurgitation (AR) associated with ventricular septal defect (VSD) were studied. One hundred thirty-six consecutive patients with type I and II VSD according to Kirklin and associates' classification were divided into two groups; group A included 50 patients with type Ia VSD without the conal muscular rim, and group B included 86 patients with type Ib VSD with the conal muscular rim, or with type II VSD. Aortic cusp prolapse was detected in 74% of group A patients and 29% of group B patients. The aortic cusp prolapse correlated negatively with preoperative left-to-right shunt ratio, mean pulmonary artery pressure, and pulmonary-to-systemic pressure ratio in both groups. In group B patients, the smaller the VSD, the higher the frequency of aortic cusp prolapse, especially when less than 4 mm. Aortic regurgitation was observed in 44% of group A patients and 24% of group B patients. All 20 patients with first grade AR underwent VSD closure, 11 with second or third grade AR underwent VSD closure plus valvuloplasty, and 1 with third grade AR underwent aortic valve replacement. Postoperative persistent AR occurred in 8 out of 32 patients, and correlated positively (p < 0.01) with the preoperative grade of AR and the number of plication stitches in both groups.