6 The LA volume was measured following recommendations for chamber quantification7 by the following equation: LA volume = 4π/3 × (PLAX/2) × (LAT/2) × (SI/2). All linear LA dimensions and LA volume to the BSA were indexed and defined as the PLAX index, LAT index, SI index, and LAV index. The chi-squared test and one-way analysis of variance (ANOVA) with Tukey’s post-hoc analysis were used to test for differences in subject characteristics

among the three groups of MR. Two-way repeated measures ANOVA with Tukey’s post-hoc analysis was used to compare the left heart echocardiographic parameters among three groups of MR according to the time. The Statistical Package for Social Sciences (SPSS) version 20.0 (SPSS Inc. – Chicago, IL, this website USA) was used for all data analyses. A total of 40 patients with VSD met the inclusion criteria: 16 patients had VSD with no preoperative MR, 15 patients had trivial to mild MR, and nine patients had moderate to severe MR. In the group with no MR, 12 patients (75.0%) had perimembranous VSD, three (18.7%) had subarterial VSD, and one (6.2%) had outlet muscular VSD. In the group with trivial to mild MR, 12 patients (80.0%) had perimembranous VSD and three (20.0%) had subarterial VSD. In the group with moderate to severe

MR, all nine patients (100.0%) had perimembranous VSD (p = 0.002). There were no statistically significant differences in age, body weight, BSA, pressure gradient through VSD, pressure gradient of tricuspid regurgitation, or the presence of ASD or PFO among the three groups (Table 1). There was Plasmin no postoperative

mortality. Patients who did not have MR preoperatively did not progress to new-onset MEK pathway MR after surgical closure of the VSD. All patients improved regarding the degree of MR. In the mild MR group (n = 15), 11 patients had trivial MR and four had mild MR preoperatively; at one month postoperatively (n = 15), 12 patients were resolved and three patients improved to a trivial degree of MR; at three months postoperatively (n = 12), 11 patients were resolved and one patient remained with trivial MR until 12 months after surgery. In the moderate to severe MR group (n = 9), six patients had moderate MR and three had severe MR preoperatively; at one month postoperatively (n = 9), MR had resolved in three patients, improved to trivial in three patients, decreased to moderate in two patients, and one patient remained with moderate MR. At three months (n = 7), four patients improved to trivial and three patients remained without MR. At 12 months, follow-up data were available for six patients; among them, MR remained trivial in two patients (Fig. 1). The echocardiographic values of LV, MV annulus, and LA enlargement are shown in Table 2. The preoperative LVEDV index, LVEDD-Z, and LVESD-Z were significantly greater in the mild MR group (p = 0.034, p = 0.034, and p = 0.039, respectively) and moderate to severe MR group (p = 0.036, p = 0.035, and p = 0.020, respectively) than in the no MR group.