Bukhari Syed M, Desai Manan, Zurakowski David, Christopher Adam, Tongut Aybala, Ozturk Mahmut, Jonas Richard A, Sinha Pranava, Yerebakan Can
Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Boston Children's Hospital, Harvard Medical School, Boston, Mass.
JTCVS Open. 2023 Jan 28;13:271-277. doi: 10.1016/j.xjon.2022.12.015. eCollection 2023 Mar.
The aim of the study was to evaluate the course of aortic valve regurgitation in patients with preoperative aortic valve regurgitation and ventricular septal defect who underwent repair of the ventricular septal defect without aortic valve repair.
A total of 37 consecutive patients with a ventricular septal defect and aortic regurgitation who underwent surgery between April 2007 and March 2016 were included in the study. Demographic, echocardiographic, operative, and clinical data were reviewed. Early and late mortality and morbidity were analyzed. Aortic regurgitation grade, left ventricular function, and dimensions were compared between the preoperative transesophageal echocardiography and postoperative transthoracic echocardiogram at last follow-up. Multivariate logistic regression analysis was performed to determine factors associated with improvement of aortic valve function.
There was no early or late mortality. No reoperations or reinterventions were required. A total of 17 patients had mild or greater aortic regurgitation preoperatively. Only 5 patients had mild or greater aortic regurgitation at follow-up of 4.3 years (0.5-10.1). Twenty-eight (76%) of the 37 patients showed an improvement in their aortic regurgitation grade. Left ventricular end-systolic and end-diastolic diameter z-scores were significantly lower at follow-up ( = .007 and = .001, respectively). Multivariable logistic regression identified low preoperative left ventricular ejection fraction as the only predictor of nonimprovement of aortic regurgitation (95% confidence interval, 0.732-0.999, = .002).
Repair of a ventricular septal defect with accompanying aortic regurgitation can be performed with excellent results without surgical intervention on the aortic valve. Accompanying aortic regurgitation, especially trivial to mild, at the time of ventricular septal defect repair improves in the majority of cases. Low preoperative left ventricular ejection fraction is predictive of nonimprovement of aortic regurgitation grade.
本研究旨在评估术前存在主动脉瓣反流及室间隔缺损且接受室间隔缺损修补术但未行主动脉瓣修补术患者的主动脉瓣反流病程。
本研究纳入了2007年4月至2016年3月期间连续37例行室间隔缺损修补术及主动脉瓣反流手术的患者。回顾了人口统计学、超声心动图、手术及临床数据。分析了早期和晚期死亡率及发病率。比较了术前经食管超声心动图与最后一次随访时术后经胸超声心动图的主动脉瓣反流分级、左心室功能及尺寸。进行多因素逻辑回归分析以确定与主动脉瓣功能改善相关的因素。
无早期或晚期死亡。无需再次手术或再次干预。共有17例患者术前存在轻度或更严重的主动脉瓣反流。在4.3年（0.5 - 10.1年）的随访中，只有5例患者存在轻度或更严重的主动脉瓣反流。37例患者中有28例（76%）主动脉瓣反流分级有所改善。随访时左心室收缩末期和舒张末期直径z评分显著降低（分别为P = 0.007和P = 0.001）。多变量逻辑回归分析确定术前左心室射血分数低是主动脉瓣反流无改善的唯一预测因素（95%置信区间，0.732 - 0.999，P = 0.002）。
对于伴有主动脉瓣反流的室间隔缺损患者，可在不进行主动脉瓣手术干预的情况下取得良好效果。室间隔缺损修补时伴有的主动脉瓣反流（尤其是轻度至轻度）在大多数情况下会改善。术前左心室射血分数低可预测主动脉瓣反流分级无改善。
