LONG-TERM OUTCOME OF AORTIC VALVOPLASTY FOR AORTIC CUSP PROLAPSE WITH REGURGITATION ASSOCIATED WITH VENTRICULAR SEPTAL DEFECT

Cheung YF, Chiu SW*, Chau AKT, Leung MP, Yung TC

Divisions of Paediatric Cardiology and Cardiothoracic Surgery*, Grantham Hospital, The University of Hong Kong, Hong Kong, China

 

Objective:  We assessed the long-term outcome of patients with ventricular septal defect (VSD) who underwent aortic valvoplasty for associated aortic cusp prolapse and aortic regurgitation (AR), and sought to determine risk factors for failure of aortic valvoplasty (AVP).

Methods:  The clinical records, echocardiographic and angiographic findings of 27 (14 boys) patients with VSD complicated by aortic cusp prolapse and AR requiring AVP were reviewed.  Failure of AVP was defined as presence of moderate to severe AR or necessity of aortic valve replacement (AVR).  Univariate analysis was performed to identify possible risk factors predisposing to failure of AVP.

Results:  The age at operation was (mean¡ÀSD) 8.5¡À3.6 years and follow-up duration 5.9¡À4.6 (median 4.6, range 0.5 to 16.7) years.  There were neither surgical nor late deaths.  The VSD was subarterial in 17 (63%) and perimembranous in 10 (37%) patients, and measured 13¡À3.3 mm in size.  The prolapsed coronary cusp was right in 19, non-coronary in 4, and both in 3 patients; 1 had a bicuspid aortic valve.  The degree of regurgitation preoperatively was mild in 5, moderate in 9, and severe in 13 patients.  Trusler's AVP technique and VSD closure were performed in all patients.   Ten patients had failure of AVP, 4 of whom had and 4 awaiting AVR.  The freedom from failure of AVP at 1, 5, 10 and 15 years was (mean¡ÀSE) 70¡À9%, 66¡À9%, 57¡À12% and 57¡À12%, respectively; while freedom from AVR was 96¡À4%, 92¡À5%, 79¡À13% and 53¡À23%, respectively.  The risk factor for failure of AVP was older age at operation (10.3 ¡À 3.7 years vs 7.5 ¡À 3.1 years, p=0.04).

Conclusions:  Early AVP for patients with significant aortic cusp prolapse and AR associated with VSD is instrumental in reducing risk of AVP failure.  Long-term follow up is indicated as half of these patients required AVR at 15 years post-valvoplasty.

 

 
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