Everting closure for interrupted aortic arch, ventricular septal defect, and severe subaortic stenosis.

Abstract

Interrupted aortic arch with ventricular septal defect in the neonate is sometimes complicated by severe subaortic stenosis from posterior deviation of the infundibular septum. We have developed a novel approach to the treatment of this condition. The infundibular septum is penetrated from the right-ventricular side to the left-ventricular outflow tract. It is compressed with patch fixation. The lower margin of the infundibular 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 and were in normal sinus rhythm without a left bundle branch block or any significant pressure gradient between the upper and lower extremities. Follow-up two-dimensional and Doppler echocardiography demonstrated no residual shunt, no left-ventricular outflow-tract pressure gradient, and no aortic regurgitation. This technique provides effective widening of the left-ventricular outflow tract, and is more safely and easily performed than conventional methods.