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Aortic insufficiency associated with complex cardiac anomalies

Published online by Cambridge University Press:  19 August 2008

Thierry A. Folliguet ,
François Laborde ,
Loїc Macé ,
Patrice Dervanian ,
Alain Dibie ,
Jean-Michel Grinda  and
Jean-Yves Neveux
Thierry A. Folliguet*
Affiliation:
From the Department of Pediatric Cardiac Surgery, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
François Laborde
Affiliation:
From the Department of Pediatric Cardiac Surgery, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
Loїc Macé
Affiliation:
Centre Médico-chirurgical de la Porte de Choisy, Paris and the Department of Pediatric-Cardiac Surgery, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
Patrice Dervanian
Affiliation:
Centre Médico-chirurgical de la Porte de Choisy, Paris and the Department of Pediatric-Cardiac Surgery, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
Alain Dibie
Affiliation:
From the Department of Pediatric Cardiac Surgery, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
Jean-Michel Grinda
Affiliation:
Centre Médico-chirurgical de la Porte de Choisy, Paris and the Department of Pediatric-Cardiac Surgery, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
Jean-Yves Neveux
Affiliation:
Centre Médico-chirurgical de la Porte de Choisy, Paris and the Department of Pediatric-Cardiac Surgery, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
*
Dr. Thierry A. Folliguet, Department of Pediatric Cardiac Surgery, Centre Médico chirurgical de la Porte de Choisy, 6 place de Port au Prince, 75013 Paris, France.
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Abstract

The purpose of this study was to determine the cause, onset, clinical outcome and treatment of aortic insufficiency developing during treatment of complex cardiac anomalies. Aortic insufficiency associated with ventricular septal defect is a well-recognized entity. Very few studies, in contrast, have addressed the development of aortic insufficiency in the presence of more complex cardiac anomalies. Ten patients were selected from two clinical centers. All patients were diagnosed with a major cardiac anomaly requiring surgical treatment. Each patient developed aortic insufficiency requiring a surgical treatment of the valve after correction or palliation of their cardiac defect. There were six males, and mean age for the series was 17 years (range 5.5 to 33 years). All patients were initially operated for repair (eight patients) or palliation (two patients) of their congenital anomaly. Five patients had tetralogy of Fallot, one had tetralogy associated with pulmonary atresia, and two patients had double outlet right ventricle, and two had complete transposition. The degree of aortic insufficiency, the amount of pulmonary stenosis present before the original procedure and the diameter of the aortic root measured before the aortic surgical procedure on the valve were assessed by angiography and echocardiography. The mean time between the last surgical procedure and the appearance of aortic regurgitation was three years, with a mean time between the last intervention and the aortic procedure of 7.3 years. The etiology of the insufficiency was explained by prolapse of an aortic leaflet in three patients. Four patients had annular dilation with central regurgitation, two patients had traumatic perforation of a leaflet, one patient had lesions consistent with endocarditis. Eight patients had dilation of the aortic root. Surgical procedures included five replacements of the aortic valve, three aortic valvoplasties, one aortic valvar replacement associated with a Glenn shunt, and one Bentall procedure. One patient died two months following an aortic valvar replacement. All patients were assessed by transthoracic echocardiography before discharged. The two main causes of aortic regurgitation, leaflet prolapse and annular dilation are age-related complications. Most patients had dilation of the aortic root from longstanding increases in aortic flow. Early repair of congenital anomalies may decrease these complications.

Keywords

Aortic valvar insufficiencyaortic leaflet prolapseaortic root dilationage-related complications
Type
Original Articles
Information
Cardiology in the Young , Volume 5 , Issue 2 , April 1995 , pp. 125 - 131
Copyright
Copyright © Cambridge University Press 1995

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References

1.Laubry, C, Pezzi, C. Traité des maladies carpentales du coeur. In:Laubry, C, Reutier, D, Soulié, P.Les soufflés de la maladie de Roger.Rev med Paris 1935: 50: 439–447.Google Scholar
2.Garamella, JJ, Cruz, AB, Heugel, WH, Dahl, JC, Jensen, NK, Berman, R.Ventricular septal defect with aortic insufficiency: successful surgical correction of both defects by the transaortic approach. Am J Cardiol 1960; 5:266–268.CrossRefGoogle Scholar
3.Okita, Y, Miki, S, Kusuhara, K, Yuichi, U, Tahata, T, Yamanaka, K, Shiraishi, S, Tamura, T, Tatsuda, N, Koie, H. Long-term results of aortic valvuloplasty for aortic regurgitation associated with ventricular septal defect. J Thorac Cardiovasc Surg 1988; 96: 769–774.CrossRefGoogle ScholarPubMed
4.Somerville, J, Brandao, A, Ross, DN.Aortic regurgitation with ventricular septal defect: surgical management and clinical features. Circulation 1970; 41: 317–330.CrossRefGoogle ScholarPubMed
5.Spencer, FC, Doyle, EF, Danilowicz, DA, Bahnson, HT, Weldon, CT.. Long-term evaluation of aortic valvuloplasty for aortic insufficiency and ventricular septal defects. J Thorac Cardiovasc Surg 1973; 65: 15–31.CrossRefGoogle Scholar
6.Starr, A, Menashe, V, Dotter, D.. Surgical correction of aortic insufficiency associated with ventricular septal defects. Surg Gynecol Obstet 160; 111:71–76.Google Scholar
7.Trusler, GA, Moes, CAF, Kidd, BSL.Repair of ventricular septal defect with aortic insufficiency. J Thorac Cardiovasc Surg 1973; 66: 394–403.CrossRefGoogle ScholarPubMed
8.Van Praagh, R, McNamara, JJ.Anatomic types of ventricular septal defect with aortic insufficiency: diagnostic and surgical considerations. Am Heart J 1968; 75: 604–619.CrossRefGoogle ScholarPubMed
9.Rey, C, Vaksmann, G, Breviere, GM, Francart, C, Dupuis, C.L'insuffisance aortique: une complication méconnue de la fermeture chirurgicale de la communication interauriculaire ostium primum. Arch Mal Coeur 1991; 84: 627–631.Google Scholar
10.Goor, DA, Lillehei, CW, Edwards, JE.Ventricular septal defect and pulmonary stenosis with and without dextroposition. Anatomic features and embryologic implications. Chest 1971; 60: 117–128.CrossRefGoogle ScholarPubMed
11.Kirklin, JW, Barrat-Boyes, BG.Cardiac Surgery. Second edition, Volume 2. Churchill Livingstone, Edinburgh, 1993, p 863, p 1469.Google ScholarPubMed
12.Frater, RWM.Aortic valve insufficiency due to aortic dilatation: correction by sinus rim adjustment. Circulation 1986; 74(Suppl 1yes): 1136–1142.Google ScholarPubMed
13.Tatsuno, K, Konno, S, Ando, M, Sakakibara, S.. Pathogenetic mechanisms of prolapsing aortic valve and aortic regurgitation associated with ventricular septal defect. Circulation 1973; 48: 1028–1037.CrossRefGoogle ScholarPubMed
14.Dimich, I, Steinfeld, L, Litwak, RS, Park, S, Silvers, N.. Subpulmonic ventricular septal defect associated with aortic insufficiency. Am J Cardiol 1973; 32: 325–328.CrossRefGoogle ScholarPubMed
15.Moreno-Cabral, RJ, Mamiya, RT, Nakamura, FF, Brainard, SC, McNamara, JJ.Ventricular septal defect and aortic insufficiency. J Thorac Cardiovasc Surg 1976; 73: 358–365.CrossRefGoogle Scholar
16.Rhodes, LA, Keane, JF, Keane, JP, Kenneth, JP, Fellows, KE, Jonas, RA, Castañeda, AR, Nadas, AS.. Long-term follow-up (to 43 years) of ventricular septal defect with audible aortic regurgitation. Am J Cardiol 1990; 66: 340–345.CrossRefGoogle Scholar
17.Hitchcock, JF, Suijker, WJL, Ksiezyckaza, E, Harinck, E, Van Mill, GJ, Ruzyllo, W, Borman, F, Meijboom, EJ.. Management of ventricular septal defect with aortic incompetence. Ann Thorac Surg 1991; 52: 70–73.CrossRefGoogle ScholarPubMed
18.Lev, M, Eckner, FAO.The pathologic anatomy of tetralogy of Fallot and its variations. Dis Chest 1964; 45: 251–260.CrossRefGoogle ScholarPubMed
19.Nagao, GI, Daoud, GI, McAdams, AJ, Schwartz, DC, Kaplan, S.Cardiovascular anomalies associated with tetralogy of Fallot. Am J Cardiol 1967; 20: 206–215.CrossRefGoogle ScholarPubMed
20.Collins, NP, Morrow, AG, Braunwald, E.Tetralogy of Fallot with rheumatic stenosis of the aortic valve. Am Heart J 1960; 60: 626–629.CrossRefGoogle ScholarPubMed
21.Bahnson, HT, Spencer, FC, Taussig, HB.Surgical treatment and follow-up of 147 cases of tetralogy of Fallot treated by correction. J Thorac Cardiovasc Surg 1962; 44: 419–426.CrossRefGoogle Scholar
22.Glancy, DL, Morrow, AG, Roberts, WC.Malformations of the aortic valve in patients with the tetralogy of Fallot. Am Heart J 1968; 76: 755–759.CrossRefGoogle ScholarPubMed
23.Matsuda, H, Ihara, K, Mori, T, Kitamura, S, Kawashima, Y.. Tetralogy of Fallot associated with aortic insufficiency. Ann Thorac Surg 1980; 29: 529–533.CrossRefGoogle ScholarPubMed
24.Capelli, H, Ross, D, Somerville, J.Aortic regurgitation in tetrad of Fallot and pulmonary atresia. Am J Cardiol 1982; 49: 1979–1983.CrossRefGoogle ScholarPubMed
25.Thubrikar, M, Piepgrass, WC, Shaner, TW, Nolan, SP.. The design of the normal aortic valve. Am J Physiol 1981; 241: H795–H801.Google ScholarPubMed
26.Campbell, M.Calcific aortic stenosis and congenital bicuspid aortic valves. Br Heart J 1968; 30: 606–616.CrossRefGoogle ScholarPubMed
27.Cosgrove, DM, Rosenkranz, ER, Hendren, WG, Bartlett, JC, Stewart, WJ.Valvuloplasty for aortic insufficiency. J Thorac Cardiovasc Surg 1991; 102: 571–577.CrossRefGoogle ScholarPubMed
28.Mills, P, Leech, G, Davies, M, Leatham, A.. The natural history of a nonstenotic bicuspid aortic valve. Br Heart J 1978; 40: 951–957.CrossRefGoogle Scholar
29.Roberts, WC.The congenitally bicuspid aortic valve. A study of 85 autopsy cases. Am J Cardiol 1970; 26: 73–83.CrossRefGoogle ScholarPubMed
30.Roberts, WC, Morrow, AG, McIntosh, CL, Jones, M, Epstein, SE.. Congenitally bicuspid aortic valve causing severe, pure aortic regurgitation without superimposed infective endocarditis. Analysis of 13 patients requiring aortic valve replacement. Am J Cardiol 1981; 47: 206–209.CrossRefGoogle ScholarPubMed
31.Carter, JB, Sethi, S, Lee, GB, Edwards, JE.. Clinicopathologic correlations: prolapse of semilunar cusps as causes of aortic insufficiency. Circulation 1971; 43: 922–932.CrossRefGoogle Scholar
32.Marcus, FI, Ronan, J, Misanik, LF, Ewy, GA. Aortic insufficiency secondary to spontaneous rupture of a fenestrated leaflet. Am Heart J 1963; 66: 675–678.CrossRefGoogle ScholarPubMed
33.Moran, SV, Casanegra, P, Maturana, G, Dubernet, J.. Spontaneous rupture of a fenestrated aortic valve: surgical treatment. J Thorac Cardiovasc Surg 1977; 73: 716–718.CrossRefGoogle ScholarPubMed
34.Carpentier, A. Cardiac valve surgery the “French correction.” J Thorac Cardiovasc Surg 1983; 86: 323–337.CrossRefGoogle ScholarPubMed
35.Cabrol, C, Guiraudon, G, Bertrand, M.Le traitement de l'insuffisance aortique par l'annuloplastie aortique. Arch Mal Coeur 1966; 59: 1305–1312.Google Scholar
36.Denyer, MH, Elliott, CM, Robicsek, F.Pericardial patch repair of aortic cusp perforation caused by cardiac catheterization. J Cardiac Surg 1988; 3: 155–157.CrossRefGoogle ScholarPubMed
37.Kawashima, Y, Danno, M, Shimizu, Y, Matsuda, H, Mimamoto, T, Fujita, T, Kozura, T, Manabe, H.Ventricular septal defect associated with aortic insufficiency. Circulation 1973; 47: 1057–1064.CrossRefGoogle ScholarPubMed
38.Soto, B, Becker, AE, Moulaert, AJ, Lie, JT, Anderson, RH.. Classification of ventricular septal defects. Br Heart J 1980; 43: 332–343.CrossRefGoogle ScholarPubMed
39.Touati, GD, Vouhé, P, Amodeo, A, Pouard, P, Mauriat, P, Leca, F, Neveux, JY.Primary repair of tetralogy of Fallot in infancy. J Thorac Cardiovasc Surg 1990; 99: 396–403.CrossRefGoogle ScholarPubMed
40.Bonhoeffer, P, Fabbrocini, M, Lecompte, Y, Cifarelli, A, Ballerini, L, Friggiola, A, Menicanti, L, Fiesta, P.Infundibular septal defect with severe aortic regurgitation: a new surgical approach. Ann Thorac Surg 1992; 53: 851–853.CrossRefGoogle ScholarPubMed
41.Kirklin, JW, Karp, RB.The Tetralogy of Fallot From a Surgical Viewpoint. WB Saunders, Philadelphia, 1970, p 34.Google Scholar
42.Becker, AE, Conner, W, Anderson, RH.Tetralogy of Fallot: A morphometric and geometric study. Am J Cardiol 1975; 35: 402–412.CrossRefGoogle ScholarPubMed
43.Devore, GR, Siassi, B, Platt, LD.. Fetal echocardiography. Aortic root dilatation. A marker for tetralogy of Fallot. Am J Obstet Gynecol 1988; 158: 129–136.CrossRefGoogle Scholar
44.Beach, PM, Bowman, FO, Kaiser, GA, Malm, JR.Total correction of tetralogy of Fallot in adolescents and adults. Circulation 1971; 43, 44(Suppl I): 137–143.CrossRefGoogle ScholarPubMed