Rhodes L A, Keane J F, Keane J P, Fellows K E, Jonas R A, Castaneda A R, Nadas A S
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.
Am J Cardiol. 1990 Aug 1;66(3):340-5. doi: 10.1016/0002-9149(90)90846-s.
From 1946 to March 1989, 92 patients (33 women and 59 men) were seen with ventricular septal defect (VSD) and audible aortic regurgitation (AR). The VSD was subcristal in 62 patients, subpulmonary in 21 and unknown in the remaining 9. The median age of onset of AR was 5.3 years. The risk of developing AR was 2.5 times greater in those with a subpulmonary VSD. The aortic valve was tricuspid in 90% and bicuspid in 10%. Prolapse was seen in 90% of those with subcristal VSD and in all with subpulmonary VSD. Pulmonary stenosis was seen in 46% of the patients with gradients ranging from 10 to 55 mm Hg. The incidence of infective endocarditis was 15 episodes/1,000 patient years. Among 20 patients followed medically, for 297 patient years, 1 died (1959) and most have been stable, including 2 followed for greater than 30 years. In the 72 patients operated on, there were 15 perioperative and 5 late deaths. Operations consisted of VSD closure alone in 7, VSD closure and valvuloplasty in 50 and VSD closure and aortic valve replacement in the other 15. Valvuloplasty was more effective in those operated on under age 10 compared to those older than 15 years (46 vs 14%). The durability of the valvuloplasty was 76% at 12 years and 51% at 18 years.
1946年至1989年3月，共诊治92例室间隔缺损（VSD）合并可闻及主动脉瓣反流（AR）的患者，其中女性33例，男性59例。62例患者的室间隔缺损位于嵴下，21例位于肺动脉瓣下，其余9例情况不明。主动脉瓣反流出现的中位年龄为5.3岁。肺动脉瓣下室间隔缺损患者发生主动脉瓣反流的风险是其他患者的2.5倍。90%的患者主动脉瓣为三尖瓣，10%为二叶瓣。嵴下室间隔缺损患者中90%出现脱垂，肺动脉瓣下室间隔缺损患者则全部出现脱垂。46%的患者存在肺动脉狭窄，压差范围为10至55 mmHg。感染性心内膜炎的发生率为每1000患者年15例。在20例接受药物治疗随访的患者中，随访297患者年，1例死亡（1959年），大多数患者病情稳定，其中2例随访时间超过30年。在72例接受手术治疗的患者中，围手术期死亡15例，晚期死亡5例。手术方式包括单纯室间隔缺损修补术7例，室间隔缺损修补术加瓣膜成形术50例，室间隔缺损修补术加主动脉瓣置换术15例。与15岁以上患者相比，10岁以下接受手术的患者瓣膜成形术效果更好（46%对14%）。瓣膜成形术12年的耐久性为76%，18年为51%。
