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The Annals of Thoracic Surgery, Vol 49, 875-880, Copyright © 1990 by The Society of Thoracic Surgeons
S Chauvaud, A Serraf, S Mihaileanu, R Soyer, P Blondeau, C Dubost and A Carpentier
Aortic valve insufficiency with ventricular septal defect is usually
treated by plication of the commissures. However, long-term deterioration
is common. We propose a new technique that corrects the aortic annulus
dilatation and the leaflet prolapse and reinforces the sinus of Valsalva.
Two groups were compared: group I (29 patients) had plication of the
prolapsed leaflet(s) and folding of the free edge; group II (26 patients)
had triangular resection of the prolapse cusp, annuloplasty, and
reinforcement of the aortic wall. The two groups were similar with
regarding to preoperative clinical data. There was no perioperative
mortality. Primary failure (aortic valve replacement) occurred in 8
patients in group I (28%) and in 2 patients in group II (8%). The rate of
secondary failure was 31% in group I and 4% in group II. The actuarial rate
of freedom from reoperation at 5 years is 55% in group I and 88% in group
II (p less than 0.05). The late mortality was 6.5% in group I and 10.9% in
group II (no difference). We conclude that aortic valve insufficiency with
ventricular septal defect is a malformation of the aortic leaflets, the
annulus, and the sinus of Valsalva, and that the proposed technique offers
a better result than the usual methods in terms of residual aortic valve
insufficiency.
ARTICLES
Ventricular septal defect associated with aortic valve incompetence: results of two surgical managements
Service de Chirurgie Cardiovasculaire, Hopital Broussais, Paris, France.
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