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(Circulation. 1964;29:862.)
© 1964 American Heart Association, Inc.

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Ventricular Septal Defect with Aortic Regurgitation

Medical and Pathologic Aspects

ALEXANDER S. NADAS M.D.¹; OTTO G. THILENIUS M.D.¹; C. GRANT LAFARGE M.D.¹; ANNA J. HAUCK M.D.¹

¹ From the Cardiology Division, Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts.

Thirty-four patients with ventricular septal defect and aortic regurgitation, representing less than 5 per cent of our patients with ventricular septal defect, are discussed.

A loud, systolic murmur, characteristic of ventricular septal defect, is noted during infancy, whereas evidences of aortic regurgitation (protodiastolic murmur and wide pulse pressure) does not usually appear until sometime between 2 and 10 years of age.

Clinical and catheterization data indicate that the principal hemodynamic load is aortic regurgitation, whereas the ventricular septal defect does not usually result in a large pulmonary blood flow or high pulmonary arterial pressure. In about 50 per cent of the patients, a significant pressure gradient across the right ventricular outflow tract exists.

Detailed pathologic studies indicate that the ventricular septal defects are high and anterior and encroach to a greater or lesser degree on the membranous bulbar septum. The right coronary cusp is the one most severely involved, and, by its prolapse, causes aortic regurgitation; the noncoronary cusp is always less severely affected. The anatomic basis of the pressure gradient observed across the right ventricular outflow tract is not always clear.

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