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Measurement of Aortic Valve Coaptation and Effective Height Using Echocardiography in Patients with Ventricular Septal Defects and Aortic Valve Prolapse

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Abstract

Decreased coaptation height in adults has been identified as a marker of early valve failure. We evaluated aortic valve coaptation and effective height in healthy children and in children with a ventricular septal defect (VSD) with aortic cusp prolapse (ACP), using echocardiography. We included 45 subjects with VSD with ACP, 27 did not develop aortic regurgitation (AR) by ACP and 18 developed AR by ACP, and 83 healthy children as controls. Aortic root anatomy was estimated using the parasternal long-axis view. We measured the diameter of aortic valve (AV), coaptation height (CH), and effective height (EH) of the aortic valve. We defined the ACH (CH/AV ratio) and AEH (EH/AV ratio) indices as follows: \(\text{ACH }\!\!~\!\!\text{ index}\left( \text{ }\!\!\%\!\!\text{ } \right)\text{= }\!\!~\!\!\text{ }\frac{\text{CH}}{\text{AV}}\text{ }\!\!\times\!\!\text{ 100, AEH }\!\!~\!\!\text{ index}\left( \text{ }\!\!\%\!\!\text{ } \right)\text{= }\!\!~\!\!\text{ }\frac{\text{EH}}{\text{AV}}\text{ }\!\!\times\!\!\text{ 100}\). There were significant differences in ACH and AEH between the groups (control vs VSD with ACP vs VSD with ACP and AR, median ACH [%], 35.1 vs 32.0 vs 22.1; median AEH [%], 52.0 vs 48.0 vs 34.4, respectively; P < 0.01]). Intra-cardiac repair (ICR) was performed in 15 cases. Significant increases were observed in ACH and AEH before and after ICR (median ACH [%], before: 27.0, after: 32.7, P < 0.05; median AEH (%), before 38.5, after 45.8, P < 0.05). Measurement of ACH and AEH may allow direct and non-invasive assessment of the severity of VSD with ACP, which could aid clinicians in determining the need and timing for surgical intervention.

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Authors and Affiliations

  1. Department of Pediatrics, Chutoen General Medical Center, Syoubugauraike 1-1, Kakegawa City, 436-8555, Japan

    Satoru Iwashima

  2. Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Hiroki Uchiyama & Takamichi Ishikawa

  3. Department of Pediatric Cardiology, Nagano Children’s Hospital, Azumino, Japan

    Kiyohiro Takigiku

  4. Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo, Japan

    Ken Takahashi

  5. Department of Pediatrics, Akita University Faculty of Medicine, Akita, Japan

    Manatomo Toyono

  6. Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

    Nao Inoue

  7. Department of Pediatric Cardiology, Shizuoka Children’s Hospital, Shizuoka, Japan

    Masaki Nii

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  1. Satoru Iwashima
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  2. Hiroki Uchiyama
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  4. Kiyohiro Takigiku
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Correspondence to Satoru Iwashima.

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This study was approved by the Ethics Committee of the respective institutions and conducted according to the principles of the Declaration of Helsinki.

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Iwashima, S., Uchiyama, H., Ishikawa, T. et al. Measurement of Aortic Valve Coaptation and Effective Height Using Echocardiography in Patients with Ventricular Septal Defects and Aortic Valve Prolapse. Pediatr Cardiol 38, 608–616 (2017). https://doi.org/10.1007/s00246-016-1555-8

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  • DOI: https://doi.org/10.1007/s00246-016-1555-8

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