Cusp-based geometric height-oriented repair of a pediatric aortic valve

Progressive aortic regurgitation can occur in pediatric patients due to root dilation with conotruncal anomalies or cusp prolapse associated with a ventricular septal defect. It is treated using various approaches influenced by personal preferences and institutional experience. We applied geometrical concepts developed for adult aortic valve repair to pediatric valves. The basal ring and sinotubular junction are downsized in relation to the geometric height of the cusp by external suture annuloplasty. The length of the cusp free margin is then adjusted with central plication, guided by measuring the effective height of the cusp. This approach facilitates the reproducibility and predictability of pediatric aortic valve repair.