The outcome of ventricular septal defect combined with aortic regurgitation after surgical repair

Objective:Ventricle septal defect(VSD)is commonly associated with aortic regurgitation and aortic leaflet prolapse due to anatomic and hemodynamic factors.The concomitant intervention of the aortic valve during VSD repair remains one of the major concerns.Moreover,little is known about the structure and hemodynamic change in the presence of postoperative progressive AR after VSD repair.Methods:From August 2012 to February 2019,VSD patients with aortic regurgitation who underwent VSD surgical repair with or without aortic valve intervention in our institution were retrospectively reviewed.Preoperative echo and postoperative echo in the followup were collected and compared.Results:The mean age of the patients on VSD repair was 3.2.Those with postoperative progressive aortic regurgitation showed significantly increased right atrium,mean pulmonary artery,valve flow velocity,and A-wave velocity,and significantly reduced right ventricle outflow tract and descending aorta flow velocity(P<0.05).Additionally,compared with no AR intervention,aortic valvuloplasty during VSD repair predispose patients to have progressive AR(P<0.05).Conclusion:There was augmented capacity in the right-heart system and increased valvular flow velocity in the left-heart system in VSD patients combined with postoperative AR.Additional aortic valvuloplasty or aortic valve replacement during surgical VSD repair might not be necessary,especially for those with no or mild AR preoperatively.Aortic valve replacement,if required,is a more appropriate alternative in halting postoperative AR progression than aortic valvuloplasty.