Ventricular Septal Defect Complicated by Infective Endocarditis of the Aortic Valve Causing Severe Aortic Regurgitation: The Role of Aortic Valve Repair
C. Shanthi DNB, Ranjit S. Madathil MD, Richard Saldanha MCh, Mahesh Vakamudi MD, Komalakshi Balakrishnan MCh

Children with ventricular septal defect (VSD) who develop severe aortic regurgitation after infective endocarditis (IE) often require aortic valve replacement. Two children (aged 4 and 3 years) with VSD presented with congestive cardiac failure (NYHA class IV) following IE. The aortic valve (both children) and pulmonary valve (one child) were severely damaged by vegetation; aortic regurgitation was grade IV. In addition to VSD closure, partial cuspal replacement using glutaraldehyde-tanned pericardium was performed in both cases to restore cusp geometry. Both children showed a dramatic postoperative improvement that was maintained during follow up. Both remained asymptomatic, with good growth, good left ventricular function and trivial aortic regurgitation. In patients with suitable anatomy, repair of the aortic valve and pericardial cusp replacement may be the procedure of choice. Moreover, long-term anticoagulation is avoided.