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Ann Thorac Surg 1991;52:70-73
© 1991 The Society of Thoracic Surgeons

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Articles

Management of ventricular septal defect with associated aortic incompetence

^a Departments of Cardiac Surgery and Cardiology, Wilhelmina Children's Hospital, University of Utrecht, Utrecht, the Netherlands
^b Division of Paediatric Cardiology, National Institute of Cardiology, Warsaw, Poland

Accepted for publication February 28, 1991.

^_* Address reprint requests to Dr Meijboom, Division of Paediatric Cardiology, Wilhelmina Children's Hospital, PO Box 18009, 3501 CA Utrecht, the Netherlands.

Twenty-two patients with a ventricular septal defect and aortic incompetence underwent surgical repair. Mean age was 9.6 years (range, 9 to 15 years). Mean follow-up was 32.4 ± 15.8 months. The ventricular septal defect was perimembranous in 19 patients and doubly committed or juxtaarterial in 3. Most showed only a small left-to-right shunt. Mean diameter was 11.9 ± 4.8 mm. Aortic incompetence was mild in 6 patients, moderate in 4, and severe in 12. In 16 patients closure of the ventricular septal defect and aortic valvoplasty were both performed through the aortic root. There were no deaths. All patients retained normal sinus rhythm. No complete heart block was found. In 3 patients secondary aortic valve replacement was required for severe incompetence; in 1 the cause was bacterial endocarditis, in another technical failure, and in a third progressive incompetence over an 8-month period. All patients showed substantial clinical improvement, marked decrease or disappearance of the valvar incompetence, diminution of the left ventricular end-diastolic diameter, and decreased cardiothoracic ratio. We conclude that primary repair is the operation of choice for this combination of lesions. This can avoid or delay considerably valvar replacement. The left-sided approach proves safe and is our preferred technique.

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