Thus, this study aimed to investigate the timing in resolution of left heart dilation according to the degree of MR in children who underwent surgical closure of VSD. The institutional review board approval for a retrospective data review was obtained (CNUH-12-192). The echocardiographic data of 40 patients under 15 years of age who had undergone surgical closure of isolated VSD by a single cardiac surgeon between January of 2009 and November of 2011 were retrospectively reviewed. Patients with small atrial septal defects (ASD) or patent foramen ovale (PFO) were included. However, patients with other associated congenital heart defects,

mTOR inhibitor therapy MV abnormalities, ventricular dysfunction, and systemic diseases, including chromosomal anomalies, were excluded. The patients with VSD were divided into three groups according to

the degree of preoperative MR, which is the degree of left heart dilation: no MR (no MR group), trivial to mild MR (mild MR group), and moderate to severe MR (moderate to severe MR group). Left heart echocardiographic characteristics of the patients in three groups at serial follow-up after surgical closure of VSD were retrospectively reviewed. MR was classified as none, trivial, mild, moderate, or severe based on qualitative color flow mapping. The changes in the degree of MR preoperatively and at one, three, and 12 months postoperatively in those who had Calpain MR before the surgical CH5424802 research buy closure of VSD were also reviewed. The following parameters through echocardiography at approximately one month preoperatively were reviewed: type of VSD, sizes and peak Doppler gradients of the VSD, and degree of MR. Body weight, height,

body surface area (BSA), and postoperative survival were also examined. At all times, including approximately one month preoperatively and at one, three, and 12 months postoperatively, the following parameters were evaluated in echocardiography: LV characteristics, including the LV end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD), and LV end-diastolic volume (LVEDV), MV annulus, LA end-systolic dimensions, and LA end-systolic volume (LA volume). The changes in echocardiographic parameters over serial follow-up times were then evaluated and compared among the three groups. LVEDD and LVESD were obtained by M-mode echocardiography, and they were converted to Z-scores. The LVEDD Z-score (LVEDD-Z) and LVESD Z-score (LVESD-Z) were calculated as the number of standard deviations from the mean value of the normal population relative to the BSA. The LVEDV was indexed to the BSA and defined as the LVEDV index. The mitral valve annulus was measured from the apical four-chamber view at mid-diastole, and the data were converted to Z-scores for inter-individual comparisons.