ANATOMIC CORRECTION OF THE SYNDROME OF PROLAPSING RIGHT CORONARY AORTIC CUSP, DILATATION OF THE SINUS OF VALSALVA, AND VENTRICULAR SEPTAL-DEFECT

Background: Although the syndrome of ventricular septal defect and aor tic regurgitation was described a long time ago, there is still no agr eement about the anatomic and functional components of the syndrome an d the optimal methods of management, Objective: Our objective was to d escribe a new simple technique of anatomic correction of all the compo nents of the syndrome, based on redefining the salient anatomic and fu nctional features of the syndrome, Methods: Anatomic correction of the syndrome is achieved through a transaortic approach with the placemen t of a series of pledget-supported mattress sutures using autogenous p ericardium, The sutures are used to close the ventricular septal defec t, plicate the aortic sinus, and correct the outward and downward disp lacement of the anulus of the aortic valve, The technique is designed to correct all the anatomic functional components including severe aor tic regurgitation when present, Results: Between 1972 and 1996, 46 pat ients with this syndrome underwent surgical treatment, The current tec hnique was used in most of the patients operated on before 1981 and in all patients since that date, There were no early or late deaths duri ng a follow-up period varying from 3 months to 24 years (mean 8.4 year s), Aortic regurgitation was abolished in 16 and improved in the remai ning patients, The hemodynamic results have been maintained except in five patients operated on early in the series, in whom additional proc edures on the cusps were performed, Conclusions: Anatomic correction o f all the components of the syndrome of prolapsing right coronary cusp , dilatation of the sinus of Valsalva, and ventricular septal defect, can be achieved by a very simple technique, This technique can be appl ied in young children and prevents progression and secondary changes, Early correction in all patients with this syndrome is warranted.