EVERTING CLOSURE FOR INTERRUPTED AORTIC-ARCH, VENTRICULAR SEPTAL-DEFECT, AND SEVERE SUBAORTIC STENOSIS

Interrupted aortic arch with ventricular septal defect in the neonate is sometimes complicated by severe subaortic stenosis from posterior d eviation of the infundibular septum, We have developed a novel approac h to the treatment of this condition, The infundibular septum is penet rated from the right-ventricular side to the left-ventricular outflow tract. It is compressed with patch fixation. The lower margin of the i nfundibular septum is everted. Three consecutive neonates were treated . The smallest diameters of the left-ventricular outflow tract were 3, 4, and 2.5 mm. All patients survived the operation and were discharged from the hospital, They remained well 2 to 7 years after the repair a nd were in normal sinus rhythm without a left bundle branch block or a ny significant pressure gradient between the upper and lower extremiti es. Follow-up two-dimensional and Doppler echocardiography demonstrate d no residual shunt, no left-ventricular outflow-tract pressure gradie nt, and no aortic regurgitation. This technique provides effective wid ening of the left-ventricular outflow tract, and is more safely and ea sily performed than conventional methods.