The following video of surgical repair of tetralogy of Fallot is presented through the courtesy of Dr. Redmond Burke, and it was carried out at Miami Children’s Hospital in Miami, Florida.
Okay, the right ventricular outflow tract is unusual. There is a large conal branch here, which we may have to sacrifice in our incision, but there is a true lad. There is an infundibular swelling and then a small annulus, a small main pulmonary artery, and a small left pulmonary artery that comes out in acute angle, so the patch on that will be difficult. We’ll probably have to use a separate patch, because that patch is going to tend to fold back on to the main pulmonary artery and kink. The RPA is well developed.
If you fill the aorta with cardioplegia, you can see that half the circumference of this vsd is formed by the aortic valve annulus.
Close VSD with pericardial patch.
We use pericardium here, because we don’t want foreing material in direct contact with the aortic valve over the child’s lifetime.
The VSD patch is being sewn to the right side of the ventricular septum – that protects the aortic valve and the conduction system.
Using a running suture technique, we just don’t see residual VSDs.
Reconstruct the left pulmonary artery.
Suture the common wall between the LPA and the MPA.
By sewing the MPA to the LPA we can prevent kinking of the MPA over the top of the LPA.
So now, we can place a regular straight transannular patch over the front wall, and it shouldn’t buckle or kink, and there shouldn’t be any buckling posteriorly between the main pulmonary artery and the LPA.
We make an effort to minimize the incision on the right ventricle, to preserve long-term function.