Closure of a ventricular septal defect through the aortic valve: a note of caution regarding resultant narrowing of the aortic valve annulus.

Closure of ventricular septal defects through the aortic valve annulus has been described for a variety of cardiac anomalies. This technique is most appropriate when simultaneous aortic valve replacement is anticipated. A continuous suture through the patch material may produce a purse-string effect upon the aortic valve annulus. The appropriate size of the aortic valve prosthesis should be determined after the closure of the ventricular septal defect is completed to avoid selecting one which may be too large.