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Eisenmenger Ventricular Septal Defect: Classification, Morphology, and Indications for Surgery

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Abstract

This study aimed to examine the definition and indications for surgery, to elucidate the morphologic substrate of aortic regurgitation, and to extrapolate the pathologic mechanisms of subpulmonary stenosis in Eisenmenger ventricular septal defect (EVSD). The study enrolled 160 patients. Preoperative respiratory symptoms and poor growth were present in 41 patients (26%), and 21 patients (13%) required mechanical ventilation. Perimembranous ventricular septal defect (pVSD) had been diagnosed previously for 136 of the patients (85%) at other institutions. Of the 160 patients, 51 (32%) had muscular posteroinferior rims. Aortic regurgitation was experienced by 36 patients (23%), found to be mild in 31 cases (19%) and moderate in 5 cases (3%). None of the patients had severe regurgitation. No aortic valvuloplasty was performed. The significant risk factors for aortic regurgitation were subpulmonary stenosis (p = 0.001) and a muscular posteroinferior rim (p = 0.000). Subpulmonary stenosis was seen in 57 patients (35%), found to be mild to moderate in 42 cases (26%) and severe in 15 cases (9%). Adequacy of the stenosis band was repaired through the tricuspid valve for 57 of these patients. The definition of EVSD should identify it as a subgroup different from pVSD, and it should be closed as soon as it is identified in developing countries. Aortic regurgitation occurs rarely, and aortic valvoplasty should be performed if it exceeds a moderate level. The subpulmonary stenosis can be repaired through the tricuspid valve.

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Acknowledgments

We thank our colleagues at Shanghai Children Medical Center for allowing us to study their patients. This work was supported by Shanghai Natural Science Foundation 09ZR1419500.

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Authors and Affiliations

  1. Department of Heart Center, Shanghai Children Medical Center, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, China

    Huiwen Chen, Zhiwei Xu, Shunmin Wang, Jia Shen, Zhifang Zhang & Haifa Hong

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  1. Huiwen Chen
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  2. Zhiwei Xu
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  3. Shunmin Wang
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  4. Jia Shen
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  5. Zhifang Zhang
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Correspondence to Zhiwei Xu.

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Chen, H., Xu, Z., Wang, S. et al. Eisenmenger Ventricular Septal Defect: Classification, Morphology, and Indications for Surgery. Pediatr Cardiol 32, 17–23 (2011). https://doi.org/10.1007/s00246-010-9797-3

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  • DOI: https://doi.org/10.1007/s00246-010-9797-3

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