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Constantine Mavroudis - One of the best experts on this subject based on the ideXlab platform.

  • Restrictive ventricular septal defect: How small is too small to close?
    The Annals of thoracic surgery, 1993
    Co-Authors: Carl L Backer, Vincent R. Zales, Alexander J Muster, Richard C. Winters, Hiroshi Takami, D. Woodrow Benson, Constantine Mavroudis
    Abstract:

    Historically, indications for ventricular septal defect closure have included congestive heart failure, pulmonary hypertension, Aortic insufficiency with or without Aortic Valve Prolapse, and prior bacterial endocarditis. However, controversy exists as to how the lifetime risk of an isolated, nonoperated restrictive ventricular septal defect compares with the risk of surgical closure in an asymptomatic child. Between 1980 and 1991, cardiac catheterization and elective ventricular septal defect closure (age > 1 year, pulmonary to systemic flow ratio < 2.0) were performed in 141 patients aged 1 to 23 years (mean age, 6.1 +/- 4.7 years). Mean systolic pulmonary artery pressure was 26.9 +/- 13.0 mm Hg, and mean pulmonary to systemic flow ratio was 1.6 +/- 0.3. Aortic Valve Prolapse was present in 63 patients (45%), Aortic insufficiency was present in 25 (18%), and 5 (3.5%) had prior bacterial endocarditis. There were no early or late deaths or major morbidity. No patient required a ventriculotomy to accomplish ventricular septal defect closure. Mean postoperative intensive care unit stay was 1.3 +/- 0.9 days, and mean hospital stay was 5.5 +/- 1.9 days. There were no instances of permanent complete atrioventricular dissociation, reoperations for bleeding, postoperative wound infections, or reoperations for residual or recurrent ventricular septal defect. These improved results justify a reevaluation of historic indications for ventricular septal defect closure.(ABSTRACT TRUNCATED AT 250 WORDS)

  • Surgical management of the conal (supracristal) ventricular septal defect
    The Journal of Thoracic and Cardiovascular Surgery, 1991
    Co-Authors: Carl L Backer, Vincent R. Zales, Serafin Y. Deleon, Alexander J Muster, Farouk S Idriss, Michel N. Ilbawi, Constantine Mavroudis
    Abstract:

    Surgical management of the conal (supracristal) ventricular septal defect differs significantly from the management of the perimembranous (infracristal) ventricular septal defect. The absence of a portion of the conal septum can lead to Prolapse of the right cusp of the Aortic Valve, which predisposes these patients to Aortic insufficiency. Between January 1980 and December 1989, 36 children with conal ventricular septal defect underwent intracardiac repair. Diagnosis was by echocardiography, cardiac catheterization, and intraoperative exploration. Preoperative evaluation showed that 26 patients (72%) had Aortic Valve Prolapse and 16 (44%) had Aortic insufficiency. Pulmonary-to-systemic flow ratios ranged from 1:1 to 3.5:1 (mean 2.0:1.0). Ten patients (27%) were believed to have clinical congestive heart failure. Age at the time of operation ranged from 2 weeks to 18 years (mean 5.5 years). Operative exposure was through the pulmonary artery (26), aorta (4), right ventricle (3), or right atrium (3). Simultaneous Aortic Valve suspension for Aortic insufficiency was performed in four patients. Operative survival was 100%. Follow-up is complete in all patients and ranges from 0.5 to 9 years (mean 4.3 years). All patients are in normal sinus rhythm. No residual ventricular septal defects have been identified. Twenty-three of 36 patients (64%) have no evidence of Aortic insufficiency; 12 of 36 (33%) have trivial or mild Aortic insufficiency. One patient with initial severe Aortic insufficiency underwent repeat Aortic valvuloplasty 3 years after ventricular septal defect closure and Aortic Valve suspension. No patients have required Aortic Valve replacement Surgical management of the conal ventricular septal defect differs from that of the perimembranous ventricular septal defect in two critical aspects. The operative approach should be through the pulmonary artery. This allows the best exposure of the remaining conal septum and the pulmonary and Aortic Valve leaflets, facilitating closure of the defect without injury to the Valves or conduction system. Conal ventricular septal defects should undergo early closure, regardless of shunt volume, to prevent progressive Aortic Valve Prolapse and Aortic insufficiency.

Carl L Backer - One of the best experts on this subject based on the ideXlab platform.

  • Restrictive ventricular septal defect: How small is too small to close?
    The Annals of thoracic surgery, 1993
    Co-Authors: Carl L Backer, Vincent R. Zales, Alexander J Muster, Richard C. Winters, Hiroshi Takami, D. Woodrow Benson, Constantine Mavroudis
    Abstract:

    Historically, indications for ventricular septal defect closure have included congestive heart failure, pulmonary hypertension, Aortic insufficiency with or without Aortic Valve Prolapse, and prior bacterial endocarditis. However, controversy exists as to how the lifetime risk of an isolated, nonoperated restrictive ventricular septal defect compares with the risk of surgical closure in an asymptomatic child. Between 1980 and 1991, cardiac catheterization and elective ventricular septal defect closure (age > 1 year, pulmonary to systemic flow ratio < 2.0) were performed in 141 patients aged 1 to 23 years (mean age, 6.1 +/- 4.7 years). Mean systolic pulmonary artery pressure was 26.9 +/- 13.0 mm Hg, and mean pulmonary to systemic flow ratio was 1.6 +/- 0.3. Aortic Valve Prolapse was present in 63 patients (45%), Aortic insufficiency was present in 25 (18%), and 5 (3.5%) had prior bacterial endocarditis. There were no early or late deaths or major morbidity. No patient required a ventriculotomy to accomplish ventricular septal defect closure. Mean postoperative intensive care unit stay was 1.3 +/- 0.9 days, and mean hospital stay was 5.5 +/- 1.9 days. There were no instances of permanent complete atrioventricular dissociation, reoperations for bleeding, postoperative wound infections, or reoperations for residual or recurrent ventricular septal defect. These improved results justify a reevaluation of historic indications for ventricular septal defect closure.(ABSTRACT TRUNCATED AT 250 WORDS)

  • Surgical management of the conal (supracristal) ventricular septal defect
    The Journal of Thoracic and Cardiovascular Surgery, 1991
    Co-Authors: Carl L Backer, Vincent R. Zales, Serafin Y. Deleon, Alexander J Muster, Farouk S Idriss, Michel N. Ilbawi, Constantine Mavroudis
    Abstract:

    Surgical management of the conal (supracristal) ventricular septal defect differs significantly from the management of the perimembranous (infracristal) ventricular septal defect. The absence of a portion of the conal septum can lead to Prolapse of the right cusp of the Aortic Valve, which predisposes these patients to Aortic insufficiency. Between January 1980 and December 1989, 36 children with conal ventricular septal defect underwent intracardiac repair. Diagnosis was by echocardiography, cardiac catheterization, and intraoperative exploration. Preoperative evaluation showed that 26 patients (72%) had Aortic Valve Prolapse and 16 (44%) had Aortic insufficiency. Pulmonary-to-systemic flow ratios ranged from 1:1 to 3.5:1 (mean 2.0:1.0). Ten patients (27%) were believed to have clinical congestive heart failure. Age at the time of operation ranged from 2 weeks to 18 years (mean 5.5 years). Operative exposure was through the pulmonary artery (26), aorta (4), right ventricle (3), or right atrium (3). Simultaneous Aortic Valve suspension for Aortic insufficiency was performed in four patients. Operative survival was 100%. Follow-up is complete in all patients and ranges from 0.5 to 9 years (mean 4.3 years). All patients are in normal sinus rhythm. No residual ventricular septal defects have been identified. Twenty-three of 36 patients (64%) have no evidence of Aortic insufficiency; 12 of 36 (33%) have trivial or mild Aortic insufficiency. One patient with initial severe Aortic insufficiency underwent repeat Aortic valvuloplasty 3 years after ventricular septal defect closure and Aortic Valve suspension. No patients have required Aortic Valve replacement Surgical management of the conal ventricular septal defect differs from that of the perimembranous ventricular septal defect in two critical aspects. The operative approach should be through the pulmonary artery. This allows the best exposure of the remaining conal septum and the pulmonary and Aortic Valve leaflets, facilitating closure of the defect without injury to the Valves or conduction system. Conal ventricular septal defects should undergo early closure, regardless of shunt volume, to prevent progressive Aortic Valve Prolapse and Aortic insufficiency.

Yasuhiro Kuroda - One of the best experts on this subject based on the ideXlab platform.

  • Echocardiographic evaluation of the development of Aortic Valve Prolapse in supracristal ventricular septal defect
    European Journal of Pediatrics, 1995
    Co-Authors: Kazuhiro Mori, Suguru Matsuoka, K. Tatara, Yasunobu Hayabuchi, Masaki Nii, Yasuhiro Kuroda
    Abstract:

    The development and timing of Aortic weve Prolapse (AoVP) and Aortic regugitation (AR) was studied by two limensional echocardiography in 99 consecutive patients with supracristal ventricular septal defect (VSD). Thirty patients (30%) had Aortic Valve Prolapse (VSD+AoVP group), and 31 patients (31%) had AoVP with AR (VSD+AoVP+AR group). In the VSD+AoVP group, AoVP was detected first by echocardiography at the age of 6.8±4.2 years (mea±SD). In the VSD+AoVP+AR group, the interval from detection of AoVP to the appearance of Al was 3.4±2.0 years. The configuration of the Prolapsed Aortic Valve was echocardiographically classified into two types: teardrop type (small) Prolapse and box type (large) Prolapse. The frequency of tear-drop tyrolapse was not significantly different between VSD+AoVP and VSD+AoVP-AR groups (43% versus 32%, respectively), indicating that even minor AoVP can result, AR. Four infants (4%) had AoVP at the ages of 1, 5, 7, and 11 months, respectively. All infants had tear-drop type Prolapse. Two infants developed AR by colour flow mapping at the ages of 3 and 11 months, and the interval from Prolapse to AR was only 2 and 4 months, respectively. Conclusion Aortic valce, involement can develop under the age of 1 year in supracristal VSD. Regular evaluation by two-dimensional echocardiography with colour flow mapping is important in the followup of children with supracristal VSD.

  • Echocardiographic evaluation of the development of Aortic Valve Prolapse in supracristal ventricular septal defect.
    European journal of pediatrics, 1995
    Co-Authors: Kazuhiro Mori, Suguru Matsuoka, K. Tatara, Yasunobu Hayabuchi, Masaki Nii, Yasuhiro Kuroda
    Abstract:

    The development and timing of Aortic weve Prolapse (AoVP) and Aortic regugitation (AR) was studied by two limensional echocardiography in 99 consecutive patients with supracristal ventricular septal defect (VSD). Thirty patients (30%) had Aortic Valve Prolapse (VSD+AoVP group), and 31 patients (31%) had AoVP with AR (VSD+AoVP+AR group). In the VSD+AoVP group, AoVP was detected first by echocardiography at the age of 6.8±4.2 years (mea±SD). In the VSD+AoVP+AR group, the interval from detection of AoVP to the appearance of Al was 3.4±2.0 years. The configuration of the Prolapsed Aortic Valve was echocardiographically classified into two types: teardrop type (small) Prolapse and box type (large) Prolapse. The frequency of tear-drop tyrolapse was not significantly different between VSD+AoVP and VSD+AoVP-AR groups (43% versus 32%, respectively), indicating that even minor AoVP can result, AR. Four infants (4%) had AoVP at the ages of 1, 5, 7, and 11 months, respectively. All infants had tear-drop type Prolapse. Two infants developed AR by colour flow mapping at the ages of 3 and 11 months, and the interval from Prolapse to AR was only 2 and 4 months, respectively.

Yukinori Moriyama - One of the best experts on this subject based on the ideXlab platform.

  • Is direct closure dangerous for treatment of doubly committed subarterial ventricular septal defect
    The Annals of thoracic surgery, 1999
    Co-Authors: Kouichi Hisatomi, Akira Taira, Yukinori Moriyama
    Abstract:

    Abstract Background . We performed direct closure of doubly committed subarterial ventricular septal defects with Aortic cusp Prolapse. Postoperative echocardiographic studies showed that this method improved coaptation of the prolapsing Aortic cusp, especially in patients with mild Aortic regurgitation (AR). Methods . Twenty-one patients (mean age, 7.8 ± 4.3 years; range, 2 to 18 years) with doubly committed subarterial ventricular septal defect underwent direct closure alone. Aortic Valve Prolapse was observed in all 21 patients, with mild AR found in 13 patients but not in the remaining 8. The site of the Prolapsed Aortic Valve was in the right coronary cusp in all patients. We inserted an interrupted 4-0 or 5-0 polypropylene suture with a pledget from the lower margin of the ventricular septal defect to the pulmonary ring to increase protrusion of the Prolapsed cusp by pushing it back and to improve coaptation of the Aortic cusp. Results . The interval between surgical treatment and the last postoperative evaluation ranged from 3 to 24 months (median, 11 months). No residual ventricular septal defect was detected in any patient. In the 8 patients who had Aortic Valve Prolapse without AR preoperatively, no AR was found at follow-up. Of the 13 patients who had mild AR associated with Aortic Valve Prolapse preoperatively, AR diminished in 7 and did not progress in the remaining 6. Furthermore, no anatomic changes in either the Aortic or pulmonary annulus were found on follow-up echocardiography. In the group of 13 patients with mild preoperative AR, AR significantly persisted in patients who were more than 10 years old at operation (p Conclusions . Our findings suggest that direct closure for this type of ventricular septal defect is safe and reliable in improving mild AR and that direct closure is more effective for younger patients in whom the prolapsing Aortic cusp is mobile enough to be protruded. However, further long-term follow-up studies will be needed to ascertain the adequacy and usefulness of the method.

  • Isolated Aortic Valve regurgitation due to degeneration of the Valve leaflet--a clinical study
    [Zasshi] [Journal]. Nihon Kyobu Geka Gakkai, 1995
    Co-Authors: Yukinori Moriyama, Toyohira H, Masaaki Koga, Watanabe S, Hideaki Saigenji, Shimokawa S, Taira A
    Abstract:

    From 1989 through 1993 thirty-eight patients underwent Aortic Valve replacement at our institution for isolated Aortic regurgitation (AR) caused by idiopathic degeneration of the Valve. There were 32 male and 6 female patients aged between 33 and 74 years with a mean of 59 years. Preoperative New York Heart Association functional class, cardiothoracic ratio, cardiac index, and left ventricular end-diastolic pressure were 2.6, 57%, 3.1 L/min/m2, and 18 mmHg, respectively. Cross-sectional echocardiography clarified Aortic Valve Prolapse in seven patients. Excised valvular cusps were thin, redundant and translucent in association with cuspal fenestration in 9 cases and idiopathic commissural disruption in 2 cases. Histological study revealed significant disruption of the fibrosa and cystic degeneration of the spongiosa layer filled with mucopolysaccharide. Actuarial survival rate, including 3 operative deaths, was 89% at 3 years after AVR with no apparent Valve related complications. Idiopathic degeneration of the Aortic Valve is a common cause of AR, occurring in half of the surgically treated patients. We emphasize the importance of this lesion as a cause of AR.

  • Surgery for ventricular septal defect with Aortic regurgitation
    Kyobu geka. The Japanese journal of thoracic surgery, 1993
    Co-Authors: Umebayashi Y, Yukinori Moriyama, Toyohira H, Hideaki Saigenji, Shimokawa S, Taira A, Toshiyuki Yuda, Shigeru Fukuda, Iguro Y, Kazuhiro Arikawa
    Abstract:

    Abstract Twenty-two patients (mean age of 12.9 years) with ventricular septal defect (VSD) associated with Aortic regurgitation (AR) were treated surgically. Sixteen patients had subpulmonic VSD and six had infracristal VSD. Fourteen patients with subpulmonic VSD underwent VSD closure alone. VSD was closed by pulling up the inferior rim to the pulmonary Valve thus support the Prolapse Aortic cusp. AR improved in two and has remained stable in eleven for 0.5 to 12.7 years (mean 4.4 years). Aortic Valve replacement (AVR) was necessary in an adult patient later. Plication of the Aortic Valve was effective in a young patient but ineffective in an adult patient. In infracristal VSD, AVR was necessary in two adult patients. In a young patient, AR improved by plication. Direct VSD closure ceased progression of AR in three patients. The long-term follow-up shows that VSD closure with our technique has been sufficient to arrest progression of AR in subpulmonic VSD. Early closure of VSD should be emphasized to prevent Aortic Valve Prolapse and regurgitation.

Kazuo Momma - One of the best experts on this subject based on the ideXlab platform.