Elsevier

The Annals of Thoracic Surgery

Volume 94, Issue 3, September 2012, Pages 1023-1025
The Annals of Thoracic Surgery

How to do it
Double-Barrel Right Ventricular Outflow: Tetralogy of Fallot Annulus Preservation Technique

https://doi.org/10.1016/j.athoracsur.2012.05.091Get rights and content

In patients with tetralogy of Fallot (TOF) repair and a borderline pulmonary valve annulus (PVA) size, surgical repair often necessitates a transannular incision and subsequent placement of a patch with or without a monocusp or, alternatively, a right ventricle–to–pulmonary artery conduit. We discuss here a technique in which the pulmonary valve annulus can be safely preserved, with infrequent postoperative issues as well as the potential for less incidence of right ventricular outflow intervention in the long term.

Section snippets

Technique

After standard midline sternotomy and full heparinization, arterial and bicaval cannulation is performed. Cardiopulmonary bypass is then established with moderate hypothermia. The aorta is then clamped followed by a single dose of cold antegrade cardioplegia to achieve arrest. The main pulmonary artery (MPA) and infundibulum are opened and inspected. The MPA opening is extended into its branches as needed. A transatrial or transventricular approach to closing the ventricular septal defect (VSD)

Comment

This technique was originally conceptualized to address TOF repair in patients with an anomalous coronary artery crossing the infundibulum in a setting of limited availability of small-valved right ventricle–to–pulmonary artery conduits. For the initial patient, a 4-mm PTFE graft was placed as previously described as a “pop-off.” Remarkably 13 years later, although the graft had already occluded, the PVA had grown to normal diameter with no disfiguration of the infundibulum or MPA. Right

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