Ventricular septal defect and aortic regurgitation

Ventricular septal defect and aortic regurgitation

Aortic regurgitation is more likely to occur in subpulmonic ventricular septal defect (VSD) than perimembranous VSD. Aortic cuspal prolapse occurs in 4 – 9% of VSDs and aortic regurgitation in 2 – 6% of VSDs. But the prevalence of aortic cusp prolapse in subpulmonic VSDs is up to 73% and the occurrence of aortic regurgitation about 52 to 78%. While 62% of those with aortic cusp prolapse along with subaortic VSD have aortic regurgitation, 77% to 90% of those with subaortic VSD and aortic regurgitation have aortic cusp prolapse. A study by Saleeb SF et al (Am J Cardiol. 2007;99:1588-92) evaluated 100 patients with subaortic VSD diagnosed in the first year of life, but did not need surgery in infancy were evaluated for the development of aortic regurgitation on follow up. The follow up period ranged from one to twenty four years with a mean of about seven years. Initial VSD size was small in 38 patients, moderate in 50 patients and large in 12 patients. Spontaneous closure of VSD occurred during the follow up period in 4 patients with at a mean age of 6 years with a range of 3.4 to 12.7 years. Three of them had small VSDs and one of them had a moderate sized VSD. Aortic cusp prolapse developed in 14 patients at a mean age of 7.1 years with a range of 0.4 to 18.4 years. The murmur of aortic regurgitation was audible in six patients at mean age of 5.1 ± 3.1 years. All of them had aortic cusp prolapse and underwent surgery with VSD closure and aortic valvuloplasty.