Aortic valve repair in patients with ventricular septal defect

Quadricuspid aortic valve is a rare anomaly, and most patients require surgery for aortic regurgitation in the 5th or 6th decades of life; only a few cases of aortic valve repair in childhood have been reported. A 3-year-old boy was scheduled for ventricular septal defect closure and aortic valve repair. Quadricuspid aortic valve was an incidental finding at operation; it was repaired by joining the left anterior and right anterior cusps. At the 9-month follow-up, the patient had no more than mild aortic regurgitation. We emphasize the importance of detecting this anomaly, especially in children with aortic valve regurgitation.

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Aortic Valve Repair for Adult Congenital Heart Disease

Circulation ◽

10.1161/circ.102.suppl_3.iii-40 ◽

2000 ◽

Vol 102 (suppl_3) ◽

Cited By ~ 1

Author(s):

Vivek Rao ◽

Glen S. Van Arsdell ◽

Tirone E. David ◽

Anthony Azakie ◽

William G. Williams

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Aortic Valve ◽

Congenital Heart ◽

Septal Defect ◽

Aortic Valve Repair ◽

Subaortic Stenosis ◽

Valve Repair ◽

Aortic Valve Leaflets

Background —Aortic valve–preserving procedures have resulted in excellent outcomes in selected patients, particularly those with normal aortic valve leaflets and dilated aortic roots. However, several congenital heart lesions are associated with abnormal aortic valve leaflets. The long-term results of aortic valve repair for these lesions are not well defined. Methods and Results —We reviewed the clinical records of 54 adult (age >18 years) patients who underwent repair of congenital abnormalities of the aortic valve between 1976 and September 1999. Follow-up data were available on 52 (96%) patients (mean 50±67 months, range 1 to 266). Patients underwent repair at a mean age of 34±14 years with associated diagnoses of subaortic stenosis (n=10), ventricular septal defect with prolapsing aortic valve (n=17), bicuspid aortic valve (n=23), sinus of Valsalva aneurysm (n=10), and bacterial endocarditis (n=2). There was 1 operative death (1.9%) and 3 late deaths. Survival at 5 and 10 years was 98±2% and 74±12%, respectively. Freedom from reoperation was 74±9% and 51±15% at 5 and 10 years, respectively. The presence of a ventricular septal defect predicted failure of valve repair (59% versus 22%, P =0.01). A bicuspid aortic valve, subaortic stenosis, or the requirement for mitral valve surgery did not affect outcomes. Conclusions —Aortic valve repair in adult patients with congenital heart disease can be performed with minimal morbidity and mortality rates. The medium-term results of repair are acceptable, regardless of valvular or associated pathology. However, only 31 patients (57%) demonstrated long-term competence of the aortic valve, suggesting that most adult patients with congenital aortic valve disease will eventually require aortic valve replacement.

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Cusp-based geometric height-oriented repair of a pediatric aortic valve

10.1510/mmcts.2020.067 ◽

2020 ◽

Keyword(s):

Aortic Valve ◽

Septal Defect ◽

Aortic Valve Repair ◽

Valve Repair ◽

Basal Ring ◽

Sinotubular Junction ◽

Effective Height ◽

Institutional Experience ◽

Conotruncal Anomalies ◽

Geometrical Concepts

Progressive aortic regurgitation can occur in pediatric patients due to root dilation with conotruncal anomalies or cusp prolapse associated with a ventricular septal defect. It is treated using various approaches influenced by personal preferences and institutional experience. We applied geometrical concepts developed for adult aortic valve repair to pediatric valves. The basal ring and sinotubular junction are downsized in relation to the geometric height of the cusp by external suture annuloplasty. The length of the cusp free margin is then adjusted with central plication, guided by measuring the effective height of the cusp. This approach facilitates the reproducibility and predictability of pediatric aortic valve repair.

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

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.3.3067 ◽

2021 ◽

Vol 37 (3) ◽

Author(s):

Tariq Waqar ◽

Muhammad Farhan Ali Rizvi ◽

Jamal Abdul Nasir ◽

Kamran Khan

Keyword(s):

Aortic Valve ◽

Ventricular Septal Defect ◽

Aortic Valve Disease ◽

Septal Defect ◽

Group Iv ◽

Single Patient ◽

Valve Repair ◽

Group Iii ◽

Group I

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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Prevalence of Leaflet Defects during Aortic Valve Repair with Normal and Aneurysmal Aortic Morphology

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0035-1544549 ◽

2015 ◽

Vol 63 (S 01) ◽

Author(s):

L. Weber ◽

S. Pfeiffer ◽

D. Mazzitelli ◽

J. Rankin ◽

C. Stamm ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Repair ◽

Valve Repair ◽

Aortic Morphology

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A Case of Unicuspid Aortic Valve Associated with a Single Coronary Artery and Ventricular Septal Defect

Choonpa Igaku ◽

10.3179/jjmu.33.75 ◽

2006 ◽

Vol 33 (1) ◽

pp. 75-81

Author(s):

Hiroko ISHIGAMI ◽

Masatsugu IWASE ◽

Keiko HYOUDO ◽

Idumi AOYAMA ◽

Mamoru ITO ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Single Coronary Artery

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Quadricuspid Aortic Valve Repair Facilitated by Geometric Ring Annuloplasty

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/15569845211003095 ◽

2021 ◽

pp. 155698452110030

Author(s):

Joseph A. McGuire ◽

Heather K. Hayanga ◽

Jeremiah W. Hayanga ◽

Daniel Sloyer ◽

Matthew Ellison ◽

...

Keyword(s):

Aortic Valve ◽

Patient Outcomes ◽

Systematic Approach ◽

Aortic Insufficiency ◽

Aortic Valve Repair ◽

Autologous Reconstruction ◽

Quadricuspid Aortic Valve ◽

Valve Repair ◽

Ring Annuloplasty ◽

Annular Geometry

Quadricuspid aortic valve (QAV) is a rare congenital anomaly often associated with aortic insufficiency. The exact anatomy of QAV is variable, and most cases have undergone aortic valve replacement. With the recognition that aortic valve repair achieves superior patient outcomes as compared to replacement, a systematic approach to autologous reconstruction of QAV is needed. This article reports 2 cases having successful repair utilizing geometric aortic annuloplasty rings, and describes a proposed scheme for repairing most QAV defects, based on relative leaflet and commissural characteristics. Using either tri-leaflet or bicuspid ring annuloplasty, the normal sub-commissural triangles can be remodeled into a 120° or 180° configuration, respectively, and then the leaflets can be sutured and plicated to fit annular geometry. With this approach, most quadricuspid valves potentially could undergo autologous reconstruction.

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