Amano Masashi, Izumi Chisato, Imamura Sari, Onishi Naoaki, Tamaki Yodo, Enomoto Soichiro, Miyake Makoto, Tamura Toshihiro, Kondo Hirokazu, Kaitani Kazuaki, Yamanaka Kazuo, Nakagawa Yoshihisa
Department of Cardiology, Tenri Hospital, Tenri, Japan.
Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Japan.
Heart. 2016 Sep 15;102(18):1479-84. doi: 10.1136/heartjnl-2015-309005. Epub 2016 May 24.
In patients with subpulmonic infundibular ventricular septal defect (VSD), postoperative progression of aortic regurgitation (AR) sometimes occurs despite early operation before the development of AR. The present study was aimed to identify the occurrence rate and predictors of late AR progression after VSD repair alone.
We retrospectively investigated 91 consecutive patients who underwent subpulmonic infundibular VSD repair alone and were followed up with echocardiography for >3 years postoperatively. The clinical backgrounds and chronological changes in postoperative AR were evaluated.
The median follow-up period after VSD repair was 13.4 years. Among 91 patients, 7 patients showed postoperative AR progression (AR progression group) and 84 patients did not (No AR progression group). No patient in AR progression group revealed more than moderate AR preoperatively. The incidence of postoperative VSD leakage was significantly higher in AR progression group than No AR progression group (43.0% vs 2.4%, respectively; p<0.01). No significant differences were present in sex, age, preoperative AR severity, VSD diameter or rate of cusp herniation. All patients in AR progression group showed deformity of the right coronary cusp or leaflet, resulting in AR progression.
Among patients with subpulmonic infundibular VSD, the incidence of late AR progression after VSD repair alone was unexpectedly high (7.7%). Postoperative VSD leakage may be a significant risk factor for late AR progression. Long-term follow-up of postoperative AR is needed even for patients who undergo VSD repair alone.
在肺动脉瓣下漏斗部室间隔缺损（VSD）患者中，尽管在主动脉瓣反流（AR）发生之前就进行了早期手术，但术后仍有时会出现AR进展。本研究旨在确定单纯VSD修复术后晚期AR进展的发生率和预测因素。
我们回顾性调查了91例连续接受单纯肺动脉瓣下漏斗部VSD修复术且术后接受超声心动图随访超过3年的患者。评估了临床背景和术后AR的时间变化。
VSD修复术后的中位随访期为13.4年。在91例患者中，7例出现术后AR进展（AR进展组），84例未出现（无AR进展组）。AR进展组术前无患者显示超过中度的AR。AR进展组术后VSD渗漏的发生率显著高于无AR进展组（分别为43.0%和2.4%；p<0.01）。在性别、年龄、术前AR严重程度、VSD直径或瓣叶脱垂率方面无显著差异。AR进展组的所有患者均显示右冠状动脉瓣叶或瓣叶畸形，导致AR进展。
在肺动脉瓣下漏斗部VSD患者中，单纯VSD修复术后晚期AR进展的发生率出乎意料地高（7.7%）。术后VSD渗漏可能是晚期AR进展的重要危险因素。即使是接受单纯VSD修复术的患者，也需要对术后AR进行长期随访。
