3|DISCUSSION
Aortic dilation is a common sequela among patients with an unrepaired
TOF. Studies have suggested that aortic dilation may be attributed to
longstanding volume overload of the ascending aorta as a result of right
ventricular outflow tract obstruction and right-to-left shunting across
the ventricular septal defect.[4],[5] VSARR is
a well-established procedure that corrects AR as a result of aortic
dilation, with recent studies suggesting that the modified David V
technique that preserves sinus-like geometry may improve annular
stabilization and hemostasis in the long term compared with those of
remodeling techniques (Yacoub/David II).[2] Also, VSARR has also
been successfully performed on patients with congenital heart
defects.[2, 3] Adachi and colleagues have reported a case of TOF
repair with VSARR on a patient who has previously undergone a left
original Blalock-Taussig shunt during infancy.[6] Our report
represents the first to describe a successfully performed VSARR
procedure on a previously unoperated adult TOF patient. In our patient,
the long-standing VSD fortunately has not caused a significant
impairment to the aortic cusps or annulus. With our previous experience,
extreme care was taken to avoid disrupting the balanced aortic root or
distorting the aortic annulus during VSD repair. To better preserve the
sinuses and considering the hemodynamics of this patient, we chose the
Yacoub technique to reconstruct the aorta.