Interventricular septal defect with aortic insufficiency--surgical considerations

Fourteen consecutive cases of ventricular septal defect (VSD) associated with aortic insufficiency (AI) are considered from a pathological and surgical point of view. In one operated patient the AI was due to previous endocarditis with perforation of both coronary cusps. In the remaining 6 cases one or 2 aortic cusps were prolapsed. Closure of VSD was accomplished with teflon patches in 6 and with direct suture in one. The aortic valve was replaced with an aortic Bjork-Shiley prosthesis in one case, and simple valve reconstruction was carried out in the remaining 6 patients. There was no mortality. In 3 patients who presented with residual AI one month after operation, the cardiothoracic ratio and the electrocardiogram have nevertheless returned progressively to normal limits. The authors favor correction at preschool age on the principle that early closure of the VSD may prevent or control the AI. However, in small children in whom the severity of AI may suggest the necessity for valve replacement, the operation is postponed as long as possible to avoid functional prosthetic stenosis later in life.