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J Thorac Cardiovasc Surg 1997;113:253-261
© 1997 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

ANATOMIC CORRECTION OF THE SYNDROME OF PROLAPSING RIGHT CORONARY AORTIC CUSP, DILATATION OF THE SINUS OF VALSALVA, AND VENTRICULAR SEPTAL DEFECT

Received for publication May 30, 1996 revisions requested July 29, 1996; revisions received Sept. 16, 1996 accepted for publication Sept. 19, 1996. Address for reprints: Professor Sir Magdi Yacoub, Imperial College of Science, Technology, and Medicine, National Heart and Lung Institute, Division of Cardiothoracic Surgery, Dovehouse Street, London SW3 6LY, United Kingdom.

Abstract

Background: Although the syndrome of ventricular septal defect and aortic regurgitation was described a long time ago, there is still no agreement about the anatomic and functional components of the syndrome and the optimal methods of management. Objective: Our objective was to describe a new simple technique of anatomic correction of all the components of the syndrome, based on redefining the salient anatomic and functional features of the syndrome. Methods: Anatomic correction of the syndrome is achieved through a transaortic approach with the placement of a series of pledget-supported mattress sutures using autogenous pericardium. The sutures are used to close the ventricular septal defect, plicate the aortic sinus, and correct the outward and downward displacement of the anulus of the aortic valve. The technique is designed to correct all the anatomic functional components including severe aortic regurgitation when present. Results: Between 1972 and 1996, 46 patients with this syndrome underwent surgical treatment. The current technique was used in most of the patients operated on before 198l and in all patients since that date. There were no early or late deaths during a follow-up period varying from 3 months to 24 years (mean 8.4 years). Aortic regurgitation was abolished in 16 and improved in the remaining patients, The hemodynamic results have been maintained except in five patients operated on early in the series, in whom additional procedures on the cusps were performed. Conclusions: Anatomic correction of all the components of the syndrome of prolapsing right coronary cusp, dilatation of the sinus of Valsalva, and ventricular septal defect, can be achieved by a very simple technique. This technique can be applied in young children and prevents progression and secondary changes. Early correction in all patients with this syndrome is warranted.

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