Surgical Repair of Congenital Bicuspid Aortic Valve, VSD, and PDA in a 9-Year-Old Child: A Case Report

Abstract

Background: The BAV–VSD–PDA complex, presenting with severe symptomatic AR and severe LVD in a paediatric patient younger than 10 years, is a very uncommon complex congenital structural heart defect. Aim: This report aims to highlight surgical management strategies and a successful single-stage management approach. Presentation of Case: A 9-year-9-month-old girl (15 kg; BMI 11.0 kg/m 2) presented with dyspnoea on exertion and fatigue. Echocardiography showed BAV with severe eccentric AR, a moderate perimembranous VSD (Lt-to-Rt shunt), a tiny PDA (Lt-to-Rt shunt), left-heart dilatation, and grade I LV systolic dysfunction (LVEF: 53%). Single-stage open-heart surgery was performed on cardiopulmonary bypass, including VSD closure with a Dacron patch, PDA ligation, and AVR with a 19 mm TTK Chitra mechanical tilting-disc valve. Recovery was smooth, with an uneventful postoperative period. Echocardiography confirmed IVS patch integrity and normal prosthetic valve function at follow-up (mean gradient: 9 mmHg), with no residual shunt. Discussion and Conclusion: In this case, single-stage repair combining VSD closure, PDA ligation, and mechanical AVR with a TTK Chitra valve was associated with a satisfactory mid-term outcome for complex paediatric BAV with AR. Careful maintenance of anticoagulation and an appropriate multidisciplinary approach to long-term follow-up are of paramount importance.