Tri-foliate pericardial patch repair of supra-valvular aortic stenosis

Conventional aortoplasty procedures do not fully restore the normal anatomy in supra-valvular aortic stenosis (SVAS), which involves the sinus rim as well as the aortic cusps. A tri-sinus repair of this condition is proposed to restore the three intercommissural distances to normal and adequately replace the tissue loss of the sinuses, for a symmetrical reconstruction of the aortic root. Two patients, aged 3 and 11 years, with localized type of supra-valvular aortic stenosis were operated, in May 1994 and February 1996. The aortic stenosing ring was opened up at three points, by extending the incision into all the three sinuses, and the defect was repaired with in situ autologous pericardium, in a tri-foliate fashion. This repair achieved a symmetrical reconstruction of the aortic root and the systolic pressure gradient was completely abolished. Postoperative aortic root angiogram, in the older of the two patients, revealed a normal appearing aortic root. The patients have been followed-up for 51 months and 30 months respectively. Echocardiography showed competent aortic valves in both the patients without any systolic gradient across the aortic valve. A tri-sinus repair of the aorta in SVAS results in a symmetrical reconstruction of the aortic root by restoring the normal intercommissural distances of all the three cusps. It also abolishes the systolic pressure gradient. Autologous untreated pericardium lends itself easily for tailoring into a tri-foliate patch.