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Published on: December 11, 2017
Doubly committed subarterial ventricular septal defect with severe aortic regurgitation: the "two-patch" technique
Alessandro Frigiola1, Raul F Abella, Alessandro Giamberti
1Pediatric Cardiac Surgery Department, Policlinico San Donato, San Donato, Milan, Italy.
Summary
The "two-patch" technique effectively repairs doubly committed subarterial ventricular septal defects with severe aortic regurgitation. This surgical approach offers a viable, reproducible option for this complex congenital heart defect.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Pediatric Cardiology
Background:
- Doubly committed subarterial ventricular septal defect (VSD) with severe aortic regurgitation (AR) due to a prolapsed aortic cusp is a complex surgical challenge.
- Existing surgical techniques may not adequately address the combined pathology, leading to suboptimal outcomes.
Purpose of the Study:
- To describe and evaluate the efficacy of a novel "two-patch" surgical technique for repairing doubly committed subarterial VSD complicated by severe AR.
- To assess the safety and long-term outcomes of this technique in a cohort of pediatric patients.
Main Methods:
- A retrospective review of 15 patients who underwent the "two-patch" technique for doubly committed subarterial VSD with severe AR since May 1990.
- The technique involves closing the VSD through the aortic valve using a patch anchored to a second patch through the prolapsed cusp, which is then secured to the aortic wall.
Main Results:
- All 15 patients (mean age 12 years) survived the procedure.
- Mean follow-up was 10 years, with 13 patients remaining in NYHA functional class I.
- Two patients required reoperation due to progression of aortic regurgitation.
Conclusions:
- The "two-patch" technique is a simple and reproducible surgical option for doubly committed subarterial VSD with severe aortic regurgitation.
- This method demonstrates favorable short- and mid-term outcomes, offering a valid alternative for this challenging cardiac malformation.
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