Ugan Atik Sezen, Guler Eroglu Ayse
Division of Pediatric Cardiology, Department of Pediatrics, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey. Electronic correspondence:
Division of Pediatric Cardiology, Department of Pediatrics, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey.
J Heart Valve Dis. 2017 Nov;26(6):616-623.
Aortic valve prolapse (AVP) and aortic regurgitation (AR) can develop in a subset of patients with ventricular septal defect (VSD). The incidence and progression of AVP and AR with VSD at long-term follow up was evaluated.
The records of 2,275 patients with isolated VSD who had been diagnosed using echocardiography at the present authors' institution between 1988 and 2014 were reviewed.
AVP was detected in 178 patients (7.8%), using echocardiography. Of 178 patients with AVP, AR was detected in 124 (AR incidence 5.4%). A total of 142 patients was followed medically during a median of 10 years after AVP had appeared. Initially, no AR was noted in 66 of these patients, trivial AR in 41, mild AR in 30, moderate in three, and severe in two. Trivial AR developed in 20 and mild in eight of 66 patients who had no AR. In 18 of 61 patients (29.5%), trivial AR progressed to mild during a median of 3.6 years, and in five of 18 patients (27.7%) mild AR progressed to moderate during a median of 2.3 years. Postoperatively, AR improved in 17 patients, remained unchanged in 12, and worsened in four at between two months and 16.5 years of follow up (median 6.6 years).
Frequent (six-month) echocardiographic evaluation in patients with perimembraneous or muscular outlet VSD after AVP and AR development may be useful. In addition, surgical intervention in patients with perimembraneous or muscular outlet VSD, AVP and mild AR may prevent the worsening of AR.
室间隔缺损（VSD）患者的一个亚组中可发生主动脉瓣脱垂（AVP）和主动脉瓣反流（AR）。评估了长期随访中VSD合并AVP和AR的发生率及进展情况。
回顾了1988年至2014年间在本作者所在机构经超声心动图诊断为孤立性VSD的2275例患者的记录。
经超声心动图检查，178例患者（7.8%）检测到AVP。在178例AVP患者中，124例检测到AR（AR发生率5.4%）。共有142例患者在AVP出现后接受了中位时间为10年的药物随访。最初，这些患者中66例未发现AR，41例有微量AR，30例有轻度AR，3例有中度AR，2例有重度AR。66例无AR的患者中，20例出现微量AR，8例出现轻度AR。61例患者中有18例（29.5%）在中位时间3.6年期间微量AR进展为轻度，18例中有5例（27.7%）在中位时间2.3年期间轻度AR进展为中度。术后，在2个月至16.5年的随访（中位时间6.6年）中，17例患者的AR有所改善，12例保持不变，4例恶化。
对于膜周部或肌部流出道VSD患者，在AVP和AR发生后进行频繁（每6个月）的超声心动图评估可能是有用的。此外，对膜周部或肌部流出道VSD、AVP和轻度AR患者进行手术干预可能会防止AR恶化。
