Redo Valve-Sparing Root Replacement for Delayed Cusp Derangement From Ventricular Septal Defect.

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Adult Congenital Heart Surgery

Background:

• Complex congenital heart disease in adults presents unique surgical challenges.
• Initial repair of ventricular septal defect and double-chambered right ventricle can lead to late complications.
• Aortic valve complications may arise from ventricular septal defect flow dynamics.

Observation:

• A 28-year-old man presented with severe aortic regurgitation two years after initial repair of ventricular septal defect and double-chambered right ventricle.
• The regurgitation was attributed to aortic cusp prolapse secondary to the ventricular septal defect flow funnel.
• The patient also had a history of anomalous right coronary artery requiring unroofing.

Findings:

• Reoperative valve-sparing aortic root replacement was performed for symptomatic severe aortic regurgitation.
• Aortic cusp repair was simultaneously conducted.
• The patient experienced an excellent outcome following the reoperative procedure.

Implications:

• Valve-sparing aortic root replacement is a viable option for managing late aortic regurgitation after congenital heart defect repair.
• Careful consideration of ventricular septal defect flow dynamics is crucial for long-term aortic valve health.
• This case highlights the importance of long-term surveillance in adult congenital heart disease patients.