Study the Role of the doubly committed subaortic VSD Patch closure as an independent risk factor in maintaining the balance of the aortic root structure and function and preventing the progression of AR in patient with VSD –AR syndrome

Abstract

Background: However, There was a controversy regarding the accurate timming for small subaortic doubly committed VSD closure, the early closure of it has been suggested to be effective in preventing the onset of AR as the lack of infundibular septal support for the aortic annulus and left to right shunting during the early systole flow creating a venturi effect which leads to displacement of the aortic valve cusp towards the right ventricle which ended by aortic valve cusp prolapse and aortic insufficiency.[1] There was no standard surgical technique for outlet VSD closure. Various surgical technique for VSD closure was descriped. Patch closure technique consider to be the most reliable and definitive surgical procedure for preventing residual VSD and displacement of the aortic annulus. Running Direct VSD closure technique is safe, easy and can maintain the aortic cusp in its normal position but it believed that the orientation of the VSD boundaries and relation to the aortic cusp was difficult so that the aortic valve cusp will be in risk of injury as well as there was a risk of downward pulling the aortic cusp towards the septum with disruption of the commissural support which may exhibit or aggravate AR which may in need for further aortic valve repair or replacement.[4]