title: Brom's three-patch technique for repair of supravalvular aortic stenosis.
abstract: 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.
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: Hazekamp
authors.forename: A P
authors.initials: AP
authors.lastname: Kappetein
authors.forename: P H
authors.initials: PH
authors.lastname: Schoof
authors.forename: J
authors.initials: J
authors.lastname: Ottenkamp
authors.forename: M
authors.initials: M
authors.lastname: Witsenburg
authors.forename: H A
authors.initials: HA
authors.lastname: Huysmans
authors.forename: A J
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome