Closure of Ventricular Septal Defect Through the Aortic Valve

¹ Division of Surgery and Pediatric Cardiology, Texas Heart Institute, the Section of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine, Houston

Closure of ventricular septal defect through the aortic valve was performed in six patients ranging in age from 20 months to 66 years. Two patients were undergoing the Mustard procedure for transposition of the great arteries. Another patient had ventricular inversion. Anomalous origin of the anterior descending coronary artery from the right coronary artery made right ventriculotomy difficult in a patient with dextrocardia and tetralogy of Fallot. In the other two patients the ventricular septal defect was noted, by angiography before operation, to be directly under the aortic valve. Three patients required Dacron patches and three required direct suture only for closure. No atrioventricular conduction defects occurred in any patient and right bundle branch block occurred in only one patient. There was no damage to the aortic leaflets or coronary arteries. The only death in the series was unrelated to the technique. The approach is limited by the size of the aortic annulus and the position of the ventricular septal defect. The transaortic approach to closure of ventricular septal defect offers an alternate method when either right ventriculotomy or the right atrial approach through the tricuspid valve is inadvisable.