Aortic valve prolapse in subpulmonic ventricular septal defect.

BACKGROUND

Ventricular septal defect (VSD) is the most common congenital heart disease worldwide. Subpulmonic type VSD is an interesting subtype due to the aortic valve complications rate, which can change the prognosis of the VSD. Higher prevalence rates have been reported with this subtype in Eastern countries but there has been no report from Thailand so far.

OBJECTIVE

1. To determine the prevalence of subpulmonic VSD. 2. To determine the prevalence and demographic data of aortic valve prolapse (AVP) and aortic regurgitation (AR) in subpulmonic VSD.

METHOD: A retrospective study of 1,977 patients with isolated VSD, diagnosed from January 1995 to June 2002 at the Cardiology Unit, Queen Sirikit National Institute of Child Health was reviewed to differentiate types of VSD. Color flow doppler echocardiogram was performed in all cases to confirm the diagnosis and differentiate the types of VSD. Patients with subpulmonic VSD were studied to find out the presence of the aortic valve prolapse and aortic regurgitation. Those who had subpulmonic VSD were called for reevaluation of aortic valve complications, from January 2000 to June 2002.

MAIN OUTCOME MEASURE: Subpulmonic VSD, aortic valve prolapse (AVP) and aortic regurgitation (AR).

RESULTS

Subpulmonic VSD was diagnosed in 312 cases (17.5%). At the mean age of 3.47 yr, AVP was found in 101 cases (32.4%) and AR was found in 54 cases (17.3%) at the first echocardiogram. Subsequent echocardiography follow-up showed that the overall number of AVP cases was 153 (49%) and AR was 84 (26.9%) at the mean age of 5.5 and 6.3 year respectively.

CONCLUSION

The prevalence of subpulmonic VSD was high among Thai children. Aortic valve complication is common in this group and can occur from early infancy. The present findings support the progressive increase in this complication with age.