Annular Growth and Valvar Function of Main Pulmonary Artery after Operation for Doubly Committed Juxtaarterial Ventricular Septal Defect

ABSTRACT

PURPOSE: Doubly committed juxtaarterial ventricular septal defect(DCJA VSD) is relatively more frequent among Asians with VSD. The potential impairments of growth of pulmonic annulus and function of pulmonary valve are possible in postoperative patients due to the anatomic location of defect. But there are few reports regarding those impairments. So we evaluated growth of the pulmonic annulus and function of pulmonic valve after an operation. METHODS: Between Jan. 1995 and Dec. 1996, twenty seven patients with DCJA VSD were operated in Dong-A University Hospital. To compare with the study group, we selected 14 perimembranous VSD patients with similar ages and body weights who were operated during same period. We reviewed medical records and video tapes for 2 years-postoperative echocardiographic findings retrospectively. Main pulmonary artery annulus and aortic annulus ratio(MPA/Ao ratio) was used to evaluate the relative growth of pulmonary artery, and we also checked the severity of pulmonic stenosis related to valvar dysfunction. RESULTS: Two years after the operation, the MPA/Ao ratio decreased significantly in DCJA VSD patients(P value 0.001, and the decrease showed positive correlation with the defect size which is standardized by defect size/aortic annulus ratio. The mean gradient through pulmonic valve was 15.68+/-5.87, but it was not influenced by defect size or severity of growth retardation of MPA. CONCLUSION: The repair of DCJA VSD can induce the growth retardation of pulmonic annulus and valvar stenosis of pulmonary artery.