Surgical repair of infundibular ventricular septal defect and aortic regurgitation.

Interpretation of the anatomy of the defect and the pathophysiology has guided the surgical technique and indications for infundibular ventricular septal defect VSD. Infundibular ventricular septal defects are located in the infundibular septum, between the two commissures of the right coronary cusp. The defect is associated with an anomaly of the right sinus of Valsalva where the transition to cusp tissue occurs higher than normally. There is development of fibrous adherences between the ventricular surface of the right coronary cusp and the crest of the septum. This reduces the height of the cusp and destabilizes the valve. The aim is to reposition the hinge point of the right coronary cusp to restore the normal height of the cusp, hence a normal surface of apposition. This is achieved with a trans-aortic approach. The major difference with other techniques described is the extensive mobilization of the cusp. The procedure is completed by a reduction of the free edge of the right coronary cusp if it is elongated. This technique is indicated in all patients with infundibular ventricular septal defect in whom an aortic regurgitation appears or increases during follow-up. Fifteen patients were operated on with this technique between 1996 and 2005. Thirteen have achieved good results at follow-up. There was one late death.