Predictors for the outcome of aortic regurgitation after cardiac surgery in patients with ventricular septal defect and aortic cusp prolapse in Saudi patients

Salih, Hiba Gaafar; Ismail, Sameh R.; Kabbani, Mohamed S.; Abu-Sulaiman, Riyadh M.

doi:10.4103/1995-705x.192559

Cited by 8 publications

(9 citation statements)

References 23 publications

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“…Albeit, Salih et al showed female gender a risk factor for later progression of disease. 20 Comparing our results to local studies, Kumari et al 4 showed 84% regression of aortic valve disease after surgical repair. They showed 57% of residual VSD which reduced to 30% after one year follow Tariq Waqar et al up.…”

Section: Repair Of Aortic Valve Prolapse and Regurgitation In Vsdsupporting

confidence: 70%

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Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect

Waqar¹,

Rizvi²,

Nasir

et al. 2021

Pak J Med Sci

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Objective: To analyze the outcome of repair of aortic valve disease associated with various types of ventricular septal defect. Methods: In a retrospective observational study design, data of seventy-two patients of ventricular septal defect (VSD) associated with aortic valve prolapse (AVP) and aortic regurgitation (AR) who was operated in Punjab Institute of cardiology from May 2016 to April 2020 was collected. Depending on presence of AR, all patients were divided in four groups. Group-I (VSD and AVP but no AR) had fifteen patients. Only VSD was closed in this group. Group-II (VSD and Mild AR) had forty patients, only VSD was closed in this group as well. Group-III (VSD and Moderate AR) had ten patients, VSD closure and aortic valve repair was done. Group-IV (VSD and severe AR) had seven patients. Aortic valve was repaired in five patients and replaced (AVR) in two patients along with VSD closure. Associated anomalies were addressed as well. Results: Group-I: Twelve out of fifteen patients (80%) showed no post-operative AR. While two patients (13.3%) showed Trace AR. Single patient (6.6%) showed mild AR. There results were unchanged after mean follow up of 36 months. Group-II: Eight out of forty patients (20%) had no AR, while eight (20%) had trace AR. Twenty-three (57.5%) patients had mild AR. Single (2.5%) patient had moderate AR. After follow up of 24 months the patient with moderate AR progressed to severe AR. We are planning to do Aortic Valve Replacement (AVR) in this case. Rest of cases showed no progression of disease. Group-III: Two out of ten patients (20%) had no AR, four (40%) had trace AR, while four (40%) had mild AR. Mean follow up was 42 months (2.5 years). Neither trace nor mild AR progressed to severe or moderate AR. Group-IV: Among seven patients, five underwent repair while two had AVR. Out of five patients who underwent aortic valve repair, four patients (57.1%) were declared mild AR, while severe AR was converted to moderate AR in single patient (14.28%). Mean follow up was 18 months. The moderate AR patient has progressed to severe AR for last six months and we are planning to do AVR in this patient. Postoperative echo of patients with AVR showed adequately functioning aortic valve with AVPG mean 10 mmHg and 15 mm Hg respectively, with no residual AR. Conclusions: Aortic regurgitation associated with VSD is a congenital lesion with continuously active aortic valve disease resulting in significant morbidity and mortality. Early diagnosis, effective treatment and meticulous follow up decelerate and in most cases arrest the disease process. doi: https://doi.org/10.12669/pjms.37.3.3067 How to cite this:Waqar T, Rizvi MFA, Nasir JA, Khan K. Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3067 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Repair Of Aortic Valve Prolapse and Regurgitation In Vsdsupporting

confidence: 70%

“…Albeit, Salih et al showed female gender a risk factor for later progression of disease. 20 …”

Section: Discussionmentioning

confidence: 99%

Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect

Waqar¹,

Rizvi²,

Nasir

et al. 2021

Pak J Med Sci

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“…Therefore, subarterial VSD requires close monitoring from the moment of diagnosis, and early surgical closure of subarterial VSD is strongly recommended once aortic valve deformity is present and even before the onset of aortic valve deformity, as preoperative AR or aortic valve prolapse are the risk factors of postoperative residual AR or AR progression [2, 4–6, 8]. However, given that there is no definite time for elective closure of subarterial VSD, some pediatric cardiologists still delay the surgical closure and wait until an aortic valve deformity develops, which may place the child at risk for developing AR progression even after the surgical closure.…”

Section: Discussionmentioning

confidence: 99%

“…Perhaps, the relatively low risk of cardiopulmonary bypass needs to overcome the benefits of preventing aortic valve complications [3]. There are many reviews about aortic valve complications associated with subarterial VSD, but there are limited data about AR progression after subarterial VSD repair [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Progression of Aortic Regurgitation After Subarterial Ventricular Septal Defect Repair: Optimal Timing of the Operation

2019

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In patients with subarterial ventricular septal defect (VSD), the progression of aortic regurgitation (AR) still remains unclear. This review is to identify the incidence of AR progression after VSD repair and to determine the optimal operation timing for subarterial VSD repair with or without aortic valve prolapse or AR. From January 2002 to December 2015, 103 patients who underwent subarterial VSD repair alone at our hospital were reviewed. All patients routinely underwent echocardiography (echo) performed by our pediatric cardiologists. The operative approach was through the pulmonary artery in all patients. The median age of patients at operation was 10 months (range 3 to 16.5 months). Eighty-nine patients (86.4%) underwent subarterial VSD closure before the age of 4 years. In the preoperative evaluation, 27.2% (28 patients) of the patients showed more than faint degree AR. The mean follow-up duration after VSD repair was 6.6 ± 4.0 years. In the latest follow-up echo after VSD repair, four patients had more than mild degree AR owing to aortic valve abnormalities or delayed operation period. Among them, AR progression occurred in only one patient (0.98%). Early and accurate assessment of the anatomical morphology of the aortic valve and optimal operation timing may be important to achieve better outcomes after repair and to prevent the development of aortic valve complications.

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“…Среди основных причин острой АР выделяют повреждения АК в результате травм [27], оперативных вмешательств [28], включая процедуры на клапане, выполненные катетерным способом [29], и осложнений инфекционного эндокардита [30]. Хроническая АР имеет намного больше причин и, кроме инфекционного эндокардита, ревматической болезни сердца [11,31] и системных заболеваний соединительной ткани [32], ответственных также и за поражение МК, развивается при дегенеративных изменениях АК (фиброкальциноз) [33,34], сифилисе [35], спондилоартритах (анкилозирующем спондилите (АСп)) [36], псориатическом [37] и реактивном артритах [38]), васкулитах с поражением артерий крупного калибра (неспецифический аортоартериит [39], гигантоклеточный артериит [40], болезнь Бехчета [41]).…”

Section: этиологияunclassified

Aortic regurgitation: epidemiologic, etiologic, and pathophysiologic characteristics

et al. 2021

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The presented review concerns aortic regurgitation which occupies a significant place in the structure of valvular heart disease. The detailed anatomic and physiologic description of the aortic valve is provided. The characteristics of sinotubular, ventricular-aortic junctions, and virtual aortic annulus are presented. There are data about prevalence of aortic regurgitation on the basis of results of population studies, indicating the increase in incidence of aortic regurgitation among individuals older 70–74 years. The detailed etiologic structure of this valvular pathology is described with specifying of the most common causes of both aortic disease and aortic cusps alterations. In particular, there are some aortic diseases, resulting in acute aortic regurgitation, including acute aortic dissection and paravalvular regurgitation in incompetence of the prosthetic aortic valve; in chronic one – idiopathic dilation of the aortic root, inherited connective tissue dysplasias (Ehlers–Danlos, Marfan, and Loeys–Dietz syndromes), bicuspid aortic valve, aortitis of various origin, seronegative arthropathies (reactive, psoriatic arthritis, ankylosing spondylitis) etc. Infective endocarditis and traumatic exposure are commonly responsible for development of acute regurgitation due to aortic cusps abnormalities. Chronic aortic regurgitation as a consequence valve defects occurs in rheumatic heart disease, degenerative changes, congenital anomalies, systemic connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis), non-specific aortoarteritis, etc. The special attention is paid to pathophysiologic features of acute and chronic aortic regurgitation in the review. Acute aortic regurgitation is characterized by sudden increase in end-diastolic volume and due to the noncompliant left ventricle of normal size, it undergoes abrupt exposure a significant pre-load and after-load which results in decrease of left ventricle systolic function and stroke volume despite on relative preservation of contractile function of myocardium. In contrast to acute aortic regurgitation it is remarkable in its chronic form slow, progressive influence by increased overload of the left ventricle with possibility to adapt driven by its gradual dilation and hypertrophy.

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Predictors for the outcome of aortic regurgitation after cardiac surgery in patients with ventricular septal defect and aortic cusp prolapse in Saudi patients

Cited by 8 publications

References 23 publications

Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect

Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect

Progression of Aortic Regurgitation After Subarterial Ventricular Septal Defect Repair: Optimal Timing of the Operation

Aortic regurgitation: epidemiologic, etiologic, and pathophysiologic characteristics

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