Imbalance of cusp width and aortic regurgitation associated with aortic cusp prolapse in ventricular septal defect

The Doppler echocardiograms of the aortic valve and associated aortic regurgitation (AR) were reviewed in 72 patients with a ventricular septal defect (VSD). Group 1 comprised 13 patients without any deformity of the aortic cusp for greater than or equal to 10 years, group 2 included 35 patients who did not develop AR for greater than or equal to 10 years after right coronary cusp prolapse (RCCP) was first detected, group 3 comprised II patients with RCCP and AR in whom the AR remained subclinical for greater than or equal to 10 years, and group 4 was 13 patients who underwent surgical treatment because of moderate to severe AR. The cusp imbalance index [width of right (R) or non- (N) coronary cusp/width of left coronary cusp (L)] was compared among the 4 groups. R/L or Nn was larger in group 4 than in groups 1-3, R/L exceeded 1.30 in all the patients in group 4, whereas it was less than 1.30 in all the patients in groups 1-3. Two patients in group 4 with non-coronary cusp prolapse had an Nn greater than 1.50. No other patients in any group had an N/L larger than 1.20. An imbalance of cusp width may predict possible progressive deterioration of AR.