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

Journal of the Korean Pediatric Society 1996;39(8):1103-1110.
Published online August 15, 1996.
Hemodynamic Status of Subpulmonic Ventricular Septal Defect in Relation to Morphologic Changes of Aortic Valve
Myung Hyun Sohn2, Jae Young Choi2, Jong Kyun Lee2, Jun Hee Sul2, Sung Kyu Lee2, Bum Koo Cho1
1Division of Cardiovascular Surgery Cardiovascular, Yonsei Cardiovascular center, Seoul, Korea
2Division of Pediatric Cardiology, Yonsei Cardiovascular center, Seoul, Korea
폐동맥판하 심실중격결손증에서 대동맥판의 형태변화에 따른 혈역학적 특징
손명현2, 최재영2, 이종균2, 설준희2, 이승규2, 조범구1
1연세대학교 의과대학 심장혈관센터 심장혈관외과
2연세대학교 의과대학 심장혈관센터 소아심장과
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).
Conclusion
: 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.
Key Words: Subpulmonic ventricular septal defect, Aortic valve prolapse, Aortic regurgitation


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