Publication Sub Type
Philippine Journal of Cardiology
CASE REPORT: Ventricular Septal Defect is the most common form of congenital heart defect accounting for 15 percent to 20 percent of all such defects, not including those occurring as part of cyanotic congenital heart defects. Aortic regurgitation as a complication is usually associated with infundibular or outlet type of VSD and occasionally with perimembranous VSD. It occurs in about 5 percent of patients with VSD. Among Asians, it occurs in 15 percent to 20 percent of children.1 Prevalence of this complication in persons with outlet VSD increases with age.2 In a local study done by Pies, J. on the Incidence of Aortic Insufficiency Among Patients With VSD it was found out that among the 237 patients with VSD it was the subpulmonic and subaortic type of VSD which had the highest incidence of associated AR by 45 percent and 11 percent respectively. As to the incidence of AR by age in patients with subpulmonic VSD, it is highest at more than 9 years of age at 60 percent, 40 percent between 3 to 8 years old, and 0% between 0 to 2 years old.3 Our case is that of an 18 year old male adolescent diagnosed to have congenital heart disease, perimembranous ventricular septal defect with severe aortic insufficiency and moderate myocardial dysfunction, who unfortunately had chronic renal failure, underwent successful aortic valve replacement with subsequent improvement of LV function, marked decreased in LV dimension and improvement of symptoms. He presented with edema, proteinuria, hypoalbuminemia and hypercholesterolemia labeling him nephrotic syndrome which turned out clinically to be steroid resistant type of nephropathy. The issue for doing renal biopsy is in question since the procedure is very risky for this patient. At present, the renal status is in stage of chronic renal failure and in due time end stage renal failure will ensue such that patient will benefit from hemodialysis and probably be a candidate for renal transplant that will enable him to enjoy years of survival. (Author)
The objective of this study is to describe outcome, post-operative complications, management, and prognosis of aortic valve replacement in perimembranous VSD with chronic aortic regurgitation, myocardial dysfunction and chronic renal failure.