HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Backer, C. L. Articles by Mavroudis, C. Search for Related Content PubMed PubMed Citation Articles by Backer, C. L. Articles by Mavroudis, C.

The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 288-295, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Surgical management of the conal (supracristal) ventricular septal defect

CL Backer, FS Idriss, VR Zales, MN Ilbawi, SY DeLeon, AJ Muster and C Mavroudis
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, Ill.

Surgical management of the conal (supracristal) ventricular septal defect differs significantly from the management of the perimembranous (infracristal) ventricular septal defect. The absence of a portion of the conal septum can lead to prolapse of the right cusp of the aortic valve, which predisposes these patients to aortic insufficiency. Between January 1980 and December 1989, 36 children with conal ventricular septal defect underwent intracardiac repair. Diagnosis was by echocardiography, cardiac catheterization, and intraoperative exploration. Preoperative evaluation showed that 26 patients (72%) had aortic valve prolapse and 16 (44%) had aortic insufficiency. Pulmonary- to-systemic flow ratios ranged from 1:1 to 3.5:1 (mean 2.0:1.0). Ten patients (27%) were believed to have clinical congestive heart failure. Age at the time of operation ranged from 2 weeks to 18 years (mean 5.5 years). Operative exposure was through the pulmonary artery (26), aorta (4), right ventricle (3), or right atrium (3). Simultaneous aortic valve suspension for aortic insufficiency was performed in four patients. Operative survival was 100%. Follow-up is complete in all patients and ranges from 0.5 to 9 years (mean 4.3 years). All patients are in normal sinus rhythm. No residual ventricular septal defects have been identified. Twenty-three of 36 patients (64%) have no evidence of aortic insufficiency; 12 of 36 (33%) have trivial or mild aortic insufficiency. One patient with initial severe aortic insufficiency underwent repeat aortic valvuloplasty 3 years after ventricular septal defect closure and aortic valve suspension. No patients have required aortic valve replacement. Surgical management of the conal ventricular septal defect differs from that of the perimembranous ventricular septal defect in two critical aspects. The operative approach should be through the pulmonary artery. This allows the best exposure of the remaining conal septum and the pulmonary and aortic valve leaflets, facilitating closure of the defect without injury to the valves or conduction system. Conal ventricular septal defects should undergo early closure, regardless of shunt volume, to prevent progressive aortic insufficiency.

This article has been cited by other articles:

				S.-N. Chiu, J.-K. Wang, M.-T. Lin, E.-T. Wu, F. L. Lu, C.-I Chang, Y.-S. Chen, I.-S. Chiu, H.-C. Lue, and M.-H. Wu Aortic Valve Prolapse Associated With Outlet-Type Ventricular Septal Defect Ann. Thorac. Surg., April 1, 2005; 79(4): 1366 - 1371. [Abstract] [Full Text] [PDF]

				N. M. Ammash and C. A. Warnes Ventricular Septal Defects in Adults Ann Intern Med, November 6, 2001; 135(9): 812 - 824. [Abstract] [Full Text] [PDF]

				J. P. Jacobs, R. P. Burke, J. A. Quintessenza, and C. Mavroudis Congenital Heart Surgery Nomenclature and Database Project: ventricular septal defect Ann. Thorac. Surg., April 1, 2000; 69(4): S25 - 35. [Abstract] [Full Text] [PDF]

				C. Mavroudis, M. Gevitz, W. S. Ring, C. L. McIntosh, and M. Schwartz The Society of Thoracic Surgeons national congenital heart surgery database report: : Analysis of the first harvest (1994-1997) Ann. Thorac. Surg., August 1, 1999; 68(2): 601 - 624. [Abstract] [Full Text] [PDF]

				K. Hisatomi, A. Taira, and Y. Moriyama Is direct closure dangerous for treatment of doubly committed subarterial ventricular septal defect? Ann. Thorac. Surg., March 1, 1999; 67(3): 756 - 758. [Abstract] [Full Text] [PDF]

				C. L. Backer Ann. Thorac. Surg., March 1, 1999; 67(3): 758 - 759. [Full Text] [PDF]

				P. M. Sanfelippo and D. A. Hector Considerations in the Surgical Management of Ventricular Septal Defect and Aortic Insufficiency: A Case Report Angiology, April 1, 1998; 49(4): 321 - 325. [Abstract] [PDF]

				H. Komai, Y. Naito, K. Fujiwara, Y. Noguchi, Y. Nishimura, and S. Uemura Surgical Strategy for Doubly Committed Subarterial Ventricular Septal Defect With Aortic Cusp Prolapse Ann. Thorac. Surg., October 1, 1997; 64(4): 1146 - 1149. [Abstract] [Full Text]