Letter:
To the editor,
We read with great interest the article “Aortic valve repair in
patients with ventricular septal defect” by Kaskar A et
al.1 We appreciate all the authors for their efforts
and contribution to the vast field of Cardiology and for expanding the
current literature. We praise all the findings of this article which
highlights the beneficial outcomes of aortic valve repair following
Ventricular Septal Defect (VSD) repair from the aspect of mortality and
intervention. However, we would like to present a few concerns in the
context of this article.
Firstly, the authors did not highlight whether any genetic mutations
were present or not. In this case, point mutation in T-Box
Transcription Factor 5 (TBX5) and GATA Binding Protein 4 (GATA4) gene
can present with cardiac malformations.2 Moreover, a TBX5 polymorphism
has also been reported to be associated with VSD.2Moreover, authors could have mentioned the effects of environmental
factors; which include maternal infections; such as influenza and
rubella, teratogens like radiation, alcohol, and untreated maternal
metabolic diseases such as phenylketonuria and maternal diabetes on
increasing the chances of development of VSD.2 Aortic
valve repair is also associated with significant improvement in patients
with Pulmonary Hypertension, which is a systemic
disease.3 Even though this is not a primary aim of the
procedure, this is indeed of great significance. Therefore, the authors
should have documented this. Research conducted in
2007,4 emphasized on how the socio-economic status of
each patient is associated with their post-operative care quality. An
isolated centered study does not have access to this kind of
information, which limits this perspective of the study. Hence the
authors should have claimed this as one of the limitations. The study
cohort comprised the younger population only; consequently, the result
could not be generalized.
Thirdly, the article mentions a case where the patient acquired valvular
damage with Infective Endocarditis (IE) after undergoing the procedure
for aortic valve repair, which became the cause of death. A complete
hematology workup could have been done to figure out the grounds
followed by a treatment plan accordingly, which could have prevented the
casualty, as supplemented by a conducted in 1975.5