Symmetric enlargement of the ascending aorta in supravalvular aortic stenosis of the diffuse type (an alternative to apico-aortic conduit).

Surgical repair of the diffuse form of supravalvular aortic stenosis, (tubular hypoplasia of ascending aorta) is a difficult problem because complete relief of the pressure gradient is not achieved by the insertion of a prosthetic graft across the non coronary sinus of Valsalva. An alternative is to use a left ventricular-aortic by-pass shunt. A more rational reconstructive operation was carried out in a 9 years old boy and consisted of an extended aortic endarterectomy and symmetrical enlargement of the supravalvular ring in all three sinuses of Valsalva with a small patch in the left coronary sinus and a large tubular prosthesis tailored with two tips into the right and the non coronary sinuses of Valsalva and the distal end sutured up to origin of the innominate artery. Relief of pressure gradient has been excellent with control study at one year.