Hemodynamic Status of Subpulmonic Ventricular Septal Defect in Relation to Morphologic Changes of Aortic Valve

ABSTRACT

PURPOSE: Subpulmonic ventricular septal defect is clinically important because the risks of aortic regurgitation and endocarditis are substantially increased. This study was conducted to evaluate the effect of hemodynamic changes induced by structural anomalies of aortic valve on the surgical outcome. METHODS: This clinical study was done by reviewing the medical records of 124 patients who were diagnosed and surgically managed at the Cardiovascular Center, Yonsei University, College of Medicine, from May 1991 to December 1994 were performed due to subpulmonic ventricular septal defect. RESULTS: The ages were between 4 months to 21 years 9 months(mean 4 years 10 months) and the sex ratio was 1.8:1 (male:female; 80:44). Patients were stratified according to the status of the aortic valves. Group 1 was comprised of those without aortic valve prolapse and aortic regurgitation, group 2 was comprised of those with only aortic valve prolapse, and group 3 had only aortic regurgitation, and group 4 had both conditions. The mean age, pulmonary arterial pressure, aortic diameter were statistically higher in group 3, those which only aortic regurgitation(p<0.05). On surgical exploration, aortic valve prolapse was found in 68(55%), and aortic regurgitation was found in 21(17%). Aortic valve prolapse was correlated with the increase in age(p<0.05), and the development of aortic valve prolapse and aortic regurgitation were statistically correlated with the decrease in pulmonary arterial pressure(p<0.05). When 108 patients were classified into 3 groups according to the degree of aortic valve prolapse and hemodynamic status around the inlet and outlet of right ventricle, higher the degree of aortic valve prolapse, the intraventricular flow was directed to inlet(p<0.05). CONCLUSIONS: Untreated subpulmonic VSD will result in aortic regurgitation and valve prolapse, thus the surgical correction is beneficial, especially performed at early age. Therefore effort should be made to carefully evaluate all patients with VSD, and if subpulmonic VSD is discovered, immediate surgical correction is should be performed.