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J Thorac Cardiovasc Surg 1999;118:252-258
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL CARDIOVASCULAR DISEASE

BROM’S THREE-PATCH TECHNIQUE FOR REPAIR OF SUPRAVALVULAR AORTIC STENOSIS

From the Departments of Cardiothoracic Surgery^a and Pediatric Cardiology,^b Leiden University Medical Centre, Leiden, The Netherlands, and the Departments of Cardiothoracic Surgery^d and Pediatric Cardiology,^c Rotterdam University Hospital, Rotterdam, The Netherlands.

Address for reprints: Mark G. Hazekamp, MD, PhD, Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, D6-S, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.

Objective: Case histories of all patients (n = 29) operated on for supravalvular aortic stenosis from 1962 to the present were reviewed to study different techniques and outcomes. The technique of symmetric aortoplasty with 3 patches (1 in each sinus) is described and compared with other methods.
Methods: Case reports were reviewed and follow-up was completed by contacting the patient’s (pediatric) cardiologist. We aimed for a last follow-up visit, including Doppler echocardiographic studies, in a period no more than 12 months earlier than December 1997. Supravalvular aortic stenosis was discrete in 25 and diffuse with involvement of the aortic arch and arch vessels in 4 patients. Additional anomalies were bicuspid aortic valve (n = 5), coarctation (n = 3), ascending aortic aneurysm (n = 1), mitral valve insufficiency (n = 2), pulmonary valvular stenosis (n = 1), and peripheral pulmonary artery stenosis (n = 2). Eleven patients had Williams syndrome and 1 patient had Noonan syndrome. Symmetric aortoplasty with 3 patches (1 in each sinus) was used in 13 patients, whereas other nonsymmetric methods (1, 2, or Y-shaped patches) were used in 16 patients. Mean follow-up was 10.5 years (range: 4 months–36 years).
Results: All techniques adequately decreased the pressure gradient. Progression of preoperative aortic valve insufficiency or de novo regurgitation was not observed except in 1 patient in whom the patches inserted were too large.
Conclusions: No difference could be demonstrated in outcome for any surgical technique; however, reconstruction of the aortic root with autologous pericardial patches in each sinus after transection of the aorta has the advantage of symmetry while restoring the normal aortic root anatomy.

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