心室中隔欠損を有する患者における大動脈基部置換術

Aortic root replacement in patients with ventricular septal defect (VSD) requires a modified surgical technique.

Between 2000 and 2022, 12 patients with aortic regurgitation and VSD underwent an operation. Their age at operation was 31.8 (SD 19.9) years. The VSD was patent in 5 patients and spontaneously or surgically closed in 7 patients. The location of the VSD was subarterial in 6 patients, perimembranous in 5, and muscular in 1 patient. The aortic valve was tricuspid in 8 patients, bicuspid in 2, and unicuspid in 2. Eight patients also had annuloaortic ectasia.

The VSDs were closed using a patch in 4 patients and directly closed in 1 patient. The aortic root procedures were valve-sparing reimplantation in 7 patients, root remodeling in 1, basal ring annuloplasty in 1, basal ring annuloplasty with sinutubular junction annuloplasty in 1, and a Ross procedure in 1 patient. Additional cusp repair was required in 9 patients. No early deaths occurred. The postoperative follow-up periods were 5.3 (3.4) years. Two patients died, and 1 underwent aortic valve replacement 4 years postoperatively. Survival was 91.7 (8.0)% at 5 years and 68.8 (20.7)% at 10 years. Freedom from aortic valve reoperation was 88.9 (10.5)% at 10 years.

Valve-sparing root reimplantation in patients with annuloaortic ectasia and VSD may require a special first row suture line. Patients with prolapsed cusps may require resuspension or cusp extension. The Ross operation can be an alternative for patients with severely deformed aortic cusps.