Key result
In patients with an outlet ventricular septal defect, moderate aortic regurgitation and the need for aortic valve surgery were significantly higher when the right coronary cusp deformity index was ≥0.30 and the imbalance index was ≥1.30.
Observational (n=316)
No
p-value: p=<0.01
Echocardiographic indices of right coronary cusp deformity and imbalance can identify patients with outlet VSDs at high risk for progressive aortic regurgitation who may require surgical closure.
Cusp indices may stratify outlet VSD risk; leaves open whether they should guide surgical timing.
BACKGROUND: The factors that may determine the evolution of right coronary cusp prolapse (RCCP) and regurgitation (AR) associated with a ventricular septal defect in the outlet septum (outlet VSD) have not been clarified. METHODS AND RESULTS: The Doppler echocardiograms of 316 patients were grouped according to both the development of RCCP, and the values of the right coronary cusp deformity index (RCCD) and the right coronary cusp imbalance index (R/L). All detected AR was </= slight, and not progressive in patients with both RCCD <0.30 and R/L <1.30. Moderate AR was detected in patients with either RCCD >/=0.30 or R/L >/=0.30. Rupture of the sinus of Valsalva was identified in patients with RCCD >/=0.30. A significantly large number of patients with both RCCD >/=0.30 and R/L >/=1.30 (p<0.01), and a few patients with either RCCD >/=0.30 or R/L >/=0.30 underwent aortic valvuloplasty or replacement. Operative outcome for AR </= slight was good. CONCLUSIONS: There is no need to close an outlet VSD with RCCP when the RCCD <0.30 and R/L <1.30 as long as the AR remains trivial, but such defects should be closed when the RCCD is >/=0.30 or R/L >/=1.30.
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Tomita et al. (2004) conducted an observational in Ventricular septal defect in the outlet septum (n=316). Right coronary cusp deformity index ≥0.30 and/or imbalance index ≥1.30 vs. Right coronary cusp deformity index <0.30 and imbalance index <1.30 was evaluated on Aortic valvuloplasty or valve replacement (p=<0.01). In patients with an outlet ventricular septal defect, moderate aortic regurgitation and the need for aortic valve surgery were significantly higher when the right coronary cusp deformity index was ≥0.30 and the imbalance index was ≥1.30.
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