Supravalvular aortic stenosis. Repair by extended aortoplasty

Enlargement of the aorta with a diamond-shaped patch of the noncoronary sinus of Valsalva may not be sufficient in severe cases of supravalvular aortic stenosis. This traditional reconstruction is asymmetric, and, if the fibrous supravalvular ring is thick and rigid, the aorta may not open wide with patch angioplasty, so that aortic obstruction may remain. Also, because aortic valve function may not be perfect after asymmetric reconstruction, there may be aortic valve incompetence or obstruction of coronary ostia by the valve cusps. A new reconstructive operation was designed and used in eight patients. All survived and are asymptomatic. The aortoplasty was extended so that the supravalvular ring was incised at two points in the noncoronary and in the right coronary sinuses of Valsalva. The area of stenosis was opened wide, and the cusps of the aortic valve were lengthened, which provided better approximation and function. A tubular Dacron prosthesis, tailored to reconstruct the aorta, provided a wide aortic cross-sectional area. This technique of extended aortoplasty for symmetric reconstruction of the aorta should provide more predictable relief of aortic obstruction and improved function of the aortic valve.