New four Patch Repair [Modified Brom’s ] Technique for Supravalvular Aortic Stenosis

Abstract

The objective of this paper is to describe the novel four-patch technique for repair of supravalvular aortic stenosis (SVAS). Supravalvular aortic stenosis is a rare malformation as a result of an abnormal thickening of the aortic wall. SVAS may present in two forms: a localized form (affecting only the aortic sinotubular junction) and a diffuse form, where the aortic arch and its side branches are also affected. We present the novel four-patch technique as modification of Brom three patch technique. After transection of the aorta at the sinotubular junction, three longitudinal incisions are made into the three sinuses. The aortic root geometry is then restored by placement of three separate patches of autologous pericardium in the opened sinuses. One additional diamond shaped pericardial patch placed anteriorly between proximal and distal aorta. This modified four patch technique provides a complete and symmetric restoration of the aortic anatomy with insignificant gradient and good short-term and potentially good long-term results. Key words: Supravalvular aortic stenosis, Brom three patch technique, Pericardial patch.