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Assessment of ventricular septal defect with aortic valvar prolapse by means of echocardiography and angiography

Published online by Cambridge University Press:  19 August 2008

Jou-Kou Wang
Affiliation:
From the Departments of Pediatrics, National Taiwan University Hospital, Taipei
Hung-Chi Lue
Affiliation:
From the Departments of Pediatrics, National Taiwan University Hospital, Taipei
Mei-Hwan Wu
Affiliation:
From the Departments of Pediatrics, National Taiwan University Hospital, Taipei
Ming-Lon Young
Affiliation:
From the Departments of Pediatrics, National Taiwan University Hospital, Taipei
Ing-Sh Chiu
Affiliation:
Surgery, National Taiwan University Hospital, Taipei
Chung-I Chang
Affiliation:
Surgery, National Taiwan University Hospital, Taipei
Shou-Hsien Hou
Affiliation:
Surgery, National Taiwan University Hospital, Taipei
Shu-Hsun Chu
Affiliation:
Surgery, National Taiwan University Hospital, Taipei
Chi-Ren Hung
Affiliation:
Surgery, National Taiwan University Hospital, Taipei

Summary

A total of 80 patients, diagnosed by echocardiography as having ventricular septal defect with aortic valvar prolapse, underwent cardiac catheterization and surgery. Echocardiographic and angiographic results were compared with surgical findings. The ventricular septal defects as observed during surgery were found to be doubly committed and subarterial in 49 (61%), muscular outlet in 10 (13%), and perimembranous in 21(26%). The location had been erroneously categorized by echocardiography and angiography in 12 (15%) and in 15 (19%) patients, respectively. Prolapse of the right coronary leaflet of the aortic valve, as documented by echocardiography, was confirmed by angiography in all but two cases. Prolapse of the noncoronary leaflet was detected by both imaging modalities in three patients. Prolapse of the right coronary and noncoronary leaflets was observed at surgery in 49 and three patients, respectively. The mean size of the ventricular septal defect, when measured by echocardiography, was significantly smaller than that found following surgical measurements (3.3±1.3 vs 8.4±3.8 mm, p<0.001). Our study showed that the ventricular septal defect was erroneously classified in the presence of prolapse of the aortic valve in 15% and 19% of our cases by echocardiography and angiography, respectively. The herniated sinus of Valsalva forming the “roof” of the ventricular septal defect probably redirected the jet across the defect to cause the errors in interpretation. Echocardiography, nevertheless, is as reliable as angiography in our hands in the follow-up of patients with ventricular septal defect opening to the outlet of the right ventricle.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1994

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References

Van Praagh, R, McNamara, J.Anatomic types of ventricular septal defect with aortic insufficiency. Diagnostic and surgical consideration. Am Heart J 1968; 75: 604619.CrossRefGoogle Scholar
Momma, K, Toyama, K, Takao, A, Ando, M, Nakazawa, M, Hirosawa, K, lmai, Y.Natural history of subarterial infundibular ventricular septal defect. Am Heart J 1984 108: 13121317.CrossRefGoogle ScholarPubMed
Tatsuno, K, Konno, S, Ando, M, Sakakibara, S.Pathogenic mechanisms of prolapsing aortic valve and aortic regurgitation associated with ventricular septal defect: anatomical, angio-graphic, and surgical considerations. Circulation 1973; 48: 10281037.CrossRefGoogle Scholar
Nadas, AS, Thilenius, OG, Lafarge, CG, Hauck, AJ.Ventricular septal defect with aortic regurgitation: medical and pathological aspects. Circulation 1964; 29: 862873.CrossRefGoogle Scholar
Karpawich, PP, Duff, DF, Mullins, CE, Cooley, DA, McNamara, DG.Ventricular septal defect with associated aortic valve insufficiency, progression ofinsufficiency and operative results in young childr1en. J Thorac Cardiovas Surg 1981; 82: 182189.Google Scholar
Lue, HC, Sung, TC, Ho, SS, Cheng, ST, Wu, MH, Tsu, SH, Hung, CR.Ventricular septal defect in Chinese with aortic valve prolapse and aortic regurgitation. Heart Vessels 1986; 2: 111116.CrossRefGoogle ScholarPubMed
Dimich, I, Steinfeld, L, Litwak, R, Park, S, Silvers, N.Subpulmonic ventricular septal defect associated with aortic insufficiency. Am J Cardiol 1973; 32: 325328.CrossRefGoogle ScholarPubMed
Kawashima, Y, Danno, M, Shimizu, Y, Matsuda, H, Miyamoto, T, Fujita, T, Kozuka, T, Manabe, H.Ventricular septal defect associated with aortic insufficiency. Anatomic classification and method of operation. Circulation 1973; 47: 10571064.CrossRefGoogle ScholarPubMed
Boone, JW, Vincent, RN, Dooley, KJ, Williams, WH.Ventricular septal defect closure without aortic valve plication in patients with aortic valve prolapse. Am J Cardiol 1990; 65: 12711273.CrossRefGoogle ScholarPubMed
Sutherland, G, Godman, MJ, Smallhorn, JE, Guiterras, P, Anderson, RH, Hunter, S.Ventricular septal defects: Two dimensional echocardiographic and morphological correlations. Br Heart J 1982; 47: 316328.CrossRefGoogle ScholarPubMed
Menahem, S, Johns, JA, Del Torso, S, Goh, TH, Venables, AW.Evaluation of aortic valve prolapse in ventricular septal defect. Br Heart J 1986; 56: 242249.CrossRefGoogle ScholarPubMed
Craig, BG, Smallhorn, JF, Burrows, P, Trusler, GA, Rowe, RD.Cross-sectional echocardiography in the evaluation of aortic cusp prolapse associated with ventricular septal defect. Am Heart J 1986; 112: 800807.CrossRefGoogle ScholarPubMed
Schmidt, KG, Cassidy, SC, Silverman, NH, Stanger, P.Doubly committed ventricular septal defects: echocardiographic features and surgical implications. J Am Coll Cardiol 1988; 12: 15381546.CrossRefGoogle ScholarPubMed
Tatsuno, K, Konno, S, Sakakibara, S.Ventricular septal defect with aortic insufficiency. Angiographic aspects and a new classification. Am Heart J 1973; 85: 1321.CrossRefGoogle Scholar
Tatsuno, K, Ando, M, Takao, A, Hatsune, K, Konno, S.Diagnostic importance of aortography in conal ventricular defect. Am Heart J 1975: 89: 171177.CrossRefGoogle Scholar
Griffin, M, Sulliavan, ID, Anderson, RH, Macartney, FJ.Doubly committed subarterial ventricular septal: new morphological criteria with echocardiographic and angiocardiographic correlation. Br Heart J 1988; 59: 474479.CrossRefGoogle ScholarPubMed
Santamaria, H, Soto, B, Ceballos, R, Bargeron, LM, Coghlan, HC, Kirklin, JW.Angiographic differentiation of types of ventricular septal defects. Am J Radiol 1983; 141: 273281.Google ScholarPubMed
Soto, B, Becker, AE, Moulaert, AJ, Lie, JT, Anderson, RH.Classification of ventricular septal defect. Br Heart J 1980; 43: 332343.CrossRefGoogle Scholar
Baker, EJ, Leung, MP, Anderson, RH, Fischer, DR, Zuberbuhler, JR.The cross sectional anatomy of ventricular septal defects: a reappraisal. Br Heart J 1988; 59: 339351.CrossRefGoogle ScholarPubMed
Ortiz, E, Robinson, PJ, Deanfield, JE, Franklin, R, Macartney, FJ, Wyse, RKH.Localization ofVSDs bysimultaneous display of superimposed color Doppler and cross sectional echocardiographic images. Br Heart J 1985; 54: 5360.CrossRefGoogle Scholar
Ludomirsky, A, Tani, L, Murphy, DJ, Huhta, JC.Usefulness of color-flow Doppler in diagnosing and in differentiating supracristal ventricular septal defect from right ventricular outflow tract obstruction. Am J Cardiol 1991; 67: 194198.CrossRefGoogle ScholarPubMed
de Leval, MR, Pozzi, M, Starnes, V, Sullivan, ID, Stark, J, Somerville, J, Anderson, RH, Deanfield, JE.Surgical management of doubly committed subarterial ventricular septal defect. Circulation 1988; 78(Supp IIIyes): III 40III 46.Google Scholar
Ando, M, Takao, A.Pathological anatomy of ventricular septal defect associated with aortic valve prolapse and regurgitation Heart Vessels 1986; 2: 117126.Google Scholar
Helmcke, F, de Souza, A, Nanda, NC, Villacosta, I, Gatewood, R Jr, Calvin, E, Soto, B.Two-dimensional and color Doppler assessment of ventricular septal defect of congenital origin. Am J Cardiol 1989; 63: 11121116.CrossRefGoogle ScholarPubMed
Fischer, DR, Baker, EJ, Anderson, RH. Echocardiographic manifestation of ventricular septal defects, In: Anderson, RH, Neches, WH, Park, SC, Zuberbuler, JR (eds). Perspectives in Pediatric Cardiology, Vol. 1. Futura Publishing Co., Inc., New York, 1988, pp 2533.Google Scholar
Backer, CL, Idriss, FS, Zales, VR. Ilbawi, MN, Deleon, SY, Muster, AJ, Mavroudis, C.Surgical management of canal (supracristal) ventricular septal defect. J Thorac Cardiovasc Surg 1991; 102: 288296.Google Scholar

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