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��SD)
8.5��3.6
years and follow-up duration 5.9��4.6 (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��3.3 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��SE)
70��9%,
66��9%,
57��12%
and 57��12%,
respectively; while freedom from AVR was 96��4%, 92��5%,
79��13%
and 53��23%,
respectively. The risk factor
for failure of AVP was older age at operation (10.3 �� 3.7 years vs 7.5 �� 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.