A simple patch technique of VSD with the progression of aortic cusp prolapse or less than mild aortic regurgitation

  • Dr Takashi Kitaichi, Department of Cardiovascular Surgery, The University of Tokushima Graduate School, Japan
  • Dr Homare Yoshida, Department of Cardiovascular Surgery, The University of Tokushima Graduate School, Japan
  • Dr Masahisa Urata, Department of Cardiovascular Surgery, The University of Tokushima Graduate School, Japan
  • Dr Tatsuo Motoki, Department of Cardiovascular Surgery, The University of Tokushima Graduate School, Japan
  • Dr Hirotsugu Kurobe, Department of Cardiovascular Surgery, The University of Tokushima Graduate School, Japan
  • Dr Tamotsu Kanbara, Department of Cardiovascular Surgery, The University of Tokushima Graduate School, Japan
  • Dr Yasunobu Hayabuchi, Department of Pediatrics, The University of Tokushima Graduate School, Japan
  • Prof Tetsuya Kitagawa, Department of Cardiovascular Surgery, The University of Tokushima Graduate School, Japan

    • OBJECTIVE: Optimal surgical technique and the timing of ventricular septal defect (VSD) with aortic cusp prolapse (ACP) remains to be determined. We have used a simple patch technique at the progression of ACP or the initial appearance of the aortic regurgitation (AR). We reviewed the patients with VSD and ACP to evaluate our tactics, retrospectively.
    PATIENTS: 24 patients with VSD and ACP, who underwent surgical repair during 1986 and 2008, enrolled in this study. The age at surgery was 6.0 ± 4.5 (0.3-17) years old. Among all patients, the location of VSD was perimembranous (2), midconus (5), and subpulmonary (16). Preoperative AR was observed at the mild grade (13), at the moderate grade (2), and at the zero grade (9). We performed simple patch technique for 22 patients with VSD, ACP and less than mild AR by the right atrial or pulmonary arterial approach. Two patients with VSD, ACP and moderate AR underwent both the above-mentioned VSD closure and the transaortic aortic valvuloplasty.
    RESULTS: There were no early and late deaths. All patients have been free from reoperation (re-aortic valve repair, aortic valve replacement). ACP improved in 17 patients, and unchanged in 7 cases one month after repair. However, among two of the latter, ACP disappeared spontaneously during long-term follow-up. Consequently, mild AR before operation improved in 12 patients (92%) after operation.
    CONCLUSION: A simple patch technique of VSD with the progression of ACP or less than mild AR is a reasonable tactics for the patients with VSD and ACP.