Subpulmonic ventricular septal defect associated with aortic insufficiency

Insufficiency of the aortic valve as a complication of ventricular septal defect appears to be more common with the subpulmonic type than with the membranous type involving the subcristal region. In an attempt to detect the early stage of the aortic insufficiency, we studied seven patients, aged 5 to 12 years, with a subpulmonic ventricular septal defect. No patient had a diastolic murmur or other clinical evidence of aortic insufficiency. The clinical diagnosis of subpulmonic ventricular septal defect was confirmed in each case by left ventriculography. Supravalvular aortography was performed in all patients and demonstrated a moderate amount of aortic regurgitation in three. These three were operated upon and their defect was closed. No patient required aortic valve surgery. Follow-up angiograms showed complete closure of the defect and absence of aortic insufficiency. Our findings suggest that in subpulmonic ventricular septal defect, early diagnosis of aortic valve regurgitation followed by surgical closure of the ventricular defect alone may correct the aortic insufficiency and preserve the integrity of the aortic valve.