Aortic valve repair in patients with ventricular septal defect or subaortic membrane

Abstract

Background: The delay in the surgical intervention of subaortic ventricular septal defect (VSD) and subaortic membrane leads to significant damage in the aortic valve, and multiple surgical interventions may be needed. We aimed to describe the pathology of the aortic valve in patients with subaortic membrane or VSD and different surgical strategies to manage the aortic regurgitation in those patients.

Methods: The study included patients who had surgery for subaortic membrane or VSD from 2017 to 2021. We reviewed strategies and surgical techniques to deal with aortic regurgitation in patients with subaortic membrane or VSD and the short and midterm outcomes.

Results: Twelve cases were included in the study; 5 cases had subaortic membrane, and 7 cases had subaortic VSD. The age ranged from 1.5 to 10 years old. Postoperative follow-up ranged from 1 to 3.5 years. We performed sub-commissural stitches and peeling of the leaflets to correct residual regurgitation. Four patients with subaortic membrane achieved satisfactory outcomes, and one patient had severe aortic regurgitation. Two patients with VSD had progression of the aortic regurgitation. Patients with failed repair had severe prolapse and thickening of the valve.

Conclusion: Severe prolapse and dense thickening of the valve were difficult pathologies to repair. The sub-commissural stitches could be mandatory to achieve good midterm results. Complete freeing and peeling of the leaflets till restoring the natural appearance is crucial.