Aortic Regurgitation After Repair of Subpulmonic VSD

Study Questions:

What is frequency of aortic regurgitation (AR) in patients after repair of subpulmonic infundibular ventricular septal defect (VSD), and what patient characteristics are associated with its development?


A retrospective review was performed at a single center. Preoperative factors and chronological changes in postoperative AR were evaluated.


A total of 122 consecutive patients underwent surgical intervention for subpulmonic VSD starting in 1972, of which 100 had follow-up echocardiography for greater than 3 years. Nine patients who underwent aortic valve surgery at the time of VSD repair were excluded from the analysis. Only one patient had moderate or greater AR at the time of VSD repair. Of the 91 patients studied, seven (7.4%) showed progressive AR postoperatively. The incidence of residual VSD was higher in the AR progression group than in the group without AR progression (43% vs 2.4%, respectively; p < 0.01). No significant differences were seen in sex, age, preoperative AR severity, VSD diameter, or rate of cusp herniation. All patients in the AR progression group showed deformity of the right coronary cusp or leaflet, resulting in AR progression.


The incidence of late AR progression is relatively high at 7.7% after closure of subpulmonic VSD. Residual VSD after repair may be a significant risk factor for late AR progression.


The initial management of subpulmonic infundibular VSD remains controversial, with some centers advocating intervention for small VSDs without AR or leaflet prolapse to decrease the long-term risk AR. This study demonstrates a relatively high (7.4%) risk of progressive AR after VSD closure. The data support the need for close long-term follow-up of AR and consideration of intervention for residual VSD.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and CHD & Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD & Pediatrics and Imaging, CHD & Pediatrics and Interventions, CHD & Pediatrics and Quality Improvement, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound

Keywords: Aortic Valve Insufficiency, Cardiac Surgical Procedures, Echocardiography, Heart Defects, Congenital, Heart Septal Defects, Ventricular, Heart Valve Diseases, Incidence, Prolapse, Risk Factors

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