SURGICAL-TREATMENT OF VENTRICULAR SEPTAL-DEFECT AND ITS SEQUELAE IN ADULTS

We operated on 20 adult patients with ventricular septal defect (VSD). In 7 of these cases (aged 36 to 51 years, average 42.6 years), VSD wa s accompanied by sequelae other than pulmonary hypertension. Concomita nt procedures in type-I VSD included a suspension of the prolapsed aor tic cusp in 2 patients, a repair of the ruptured sinus of Valsalva in 2, and a new procedure for active infective endocarditis, described be low, in 2. In this latter procedure, the aortic valve and infected Val salva sinus were excised, and the pulmonary valve and the right ventri cular wall to which the infection had extended were thoroughly debride d. The resulting defect was closed with a single patch, and a prosthet ic valve was inserted in the position of the original aortic valve usi ng this patch as part of the annulus. Another patient with the type-II VSD underwent concomitant tricuspid valve replacement for infective e ndocarditis. In the mean follow-up period of 77.1 months, 6 patients h ave been doing well in New York Heart Association class I, and the rem aining patient with Valsalva repair remained in class II due to dilate d cardiomyopathy.