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J Thorac Cardiovasc Surg 1994;108:396-397
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Aortoplasty for aortic regurgitation with ventricular septal defect

Second Department of Surgery^a
Department of Pediatrics^b
Kurume University Hospital
Kurume, Japan

To the Editor:

Valvuloplasty is commonly performed for treatment of aortic regurgitation with ventricular septal defect (VSD) in younger patients, and several conservative procedures for aortic valve repair have been reported ^1-3 In this study, we observed patients who underwent aortoplasty, and we discuss the mid-term clinical results of this operation.

Eleven patients underwent aortoplasty between March 1976 and January 1988. The age at operation ranged from 2 to 21 years (mean 7.2 years). The degree of aortic regurgitation was determined from aortic root angiography and was classified by the criteria of Sellers and associates. ⁴ Preoperative regurgitation was grade II in one and grade III in ten patients. The predominant location of the VSD was conal in ten and perimembranous in one patient. The site of the prolapsed aortic valve was mainly in the right coronary cusp in all patients. Ascending aortic and bicaval cannulation was used for all operations. Continuous coronary perfusion was used before 1978; since then, cardiac arrest has been induced with crystalloid cardioplegic solution administered through the coronary ostium. The VSD was closed through the pulmonary artery or right ventricle. A transverse incision of the aorta was used for the aortic valve repair. The techniques of aortoplasty are shown in Fig. 1. Aortic valve coaptation was examined by placement of one stitch between each cusp, and the position of the plication was determined. If coaptation was not sufficient after valvuloplasty (plication, plication plus commissuroplasty), aortoplasty was added to make the aortic cusps protrude. Improvement in coaptation of the aortic cusp was confirmed by filling the repaired valve with saline solution. During the follow-up period, deterioration of aortic valve repair was judged to have occurred if at least one of the following signs was present: (1) murmur of aortic regurgitation greater than Levine grade 3/6; (2) cardiothoracic ratio greater than 0.55, or (3) a serious degree of aortic regurgitation detectable on the echocardiogram. Postoperative angiography was performed for seven patients. All patients were examined with Doppler color flow mapping (Aloka Color Doppler SSD-870; Aloka Co., Tokyo, Japan) between January and June 1993 to determine the degree of regurgitation. The obtained images were traced, measured for severity of aortic regurgitation, and divided into three categories based on the report of Omoto and associates ⁵: mild, with imaging of regurgitation in the subaortic region; moderate, with imaging of regurgitation localized between the left ventricular outflow tract and the free edge of the anterior mitral leaflet; or severe, with imaging of regurgitation in the left ventricular chamber beyond the anterior leaflet. Cumulative rates of freedom from deterioration of the repaired aortic valve were calculated by means of the Kaplan-Meier method.

View larger version (45K): [in this window] [in a new window]   Fig. 1. Aortoplasty.

View larger version (8K): [in this window] [in a new window]   Fig. 2. Freedom from deterioration rates in patients with aortoplasty.

References

1. Spencer FC, Doyle EF, Danielowicz DA, Bahson HT, Weldon CS. Long-term evaluation of aortic valvuloplasty for aortic insufficiency and ventricular septal defect. J THORAC CARDIOVASC SURG 1973;65:15-31.[Medline]
   
2. Chauvaud S, Serraf A, Mihaileanu S, et al. Ventricular septal defect associated with aortic incompetence: results of two surgical managements. Ann Thorac Surg 1990;49:875-80.[Abstract/Free Full Text]
   
3. Bonhoeffer P, Fabbrocini M, Lecompte Y, et al. Infundibular septal defect with severe aortic regurgitation: a new surgical approach. Ann Thorac Surg 1992;53:851-3.[Abstract/Free Full Text]
   
4. Sellers RD, Levy MJ, Amplatz K, Lillehei CW. Left retrograde cardioangiography in acquired cardiac disease. Am J Cardiol 1964;14:437-47.[Medline]
   
5. Omoto R, Yokote Y, Takamoto S, et al. The development of real-time two-dimensional Doppler echocardiography and its clinical significance in acquired valvular diseases: with special reference to the evaluation of valvular regurgitation. Jpn Heart J 1984;25:325-40[Medline]
   

This article has been cited by other articles:

				K. Hisatomi, A. Taira, S. Oku, and Y. Moriyama New valid technique for ventricular septal defect associated with aortic regurgitation J. Thorac. Cardiovasc. Surg., March 1, 1998; 115(3): 733 - 733. [Full Text]

This Article Alert me when this article is cited Alert me if a correction is posted 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 Author home page(s): Kouichi Hisatomi Tadashi Isomura Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hisatomi, K. Articles by Kato, H. Search for Related Content PubMed PubMed Citation Articles by Hisatomi, K. Articles by Kato, H.