Clinical Study of Subarterial Ventricular Septal Defect

ABSTRACT

PURPOSE: The incidence of subarterial ventricular septal defect(SA VSD) ranges 25-30% among oriental patients with VSDs, which is greater than 5% reported in western. Natural history of the disease is characterized by progressive aortic valve prolapse(AVP), frequently subarterial VSD, we evaluated clinical characteristics emphasizing on the incidence of AVP and the degree of AI as aging. METHODS: Study subjects consisted of 140 patients, who were diagnosed as subarterial VSD and operated in Seoul paik Hospital during a 5 year period from Jan.1988 to Dec. 1992. The data were analyzed detrospectively as to clinical profiles, data of cardiac catheterization, frequencies of AVP, and AI in 5 each age group, operative methods, postoperative complications and mortality. RESULTS: The incidence of subarteial VSD was 34.6% of total operated VSD cases. Data of preoperative cardiac catheterization showed mean values of Qp/Qs and systolic pulmonary artery pressure, 1.43+/-0.47 and 33.8x16.4mmHg in each. Aortic valve prolapses and aortic insufficiencies were observed in 70.0% and 20.7% among patients, which showed increasing tendencies as ages increased. As operative methods, patch closures through main pulmonary artery were done mainly. In mild cases without AI or with grade I AI, simple VSD closures were performed but in more a advanced cases, 10 aortic valvuloplasties and additional 2 aortic valve replacements were performed. Total mortality rate was 2.1%. CONCLUSIONS: In the management of subarterial VSD, early elective closure regardless of shunt volume is important to prevent progressive aortic valve prolapse leading to aortic insufficiency.