Novel Technique for Tetralogy of Fallot Repair with Transannular Patch Using Pedicled Own Pericardium

Abstract

In the surgical repair of the tetralogy of Fallot with a narrow pulmonary valve annulus, the transannular patch method is used for right ventricular outflow tract repair. To prevent pulmonary regurgitation and valve calcification, we created and applied a new transannular patch method using pedicled own pericardium in a 5-month-old boy with tetralogy of Fallot. After closing the ventricular septal defect as usual with a 0.4 mm Gore-Tex sheet, we decided that the pulmonary valve could not be spared, because the pulmonary valve opening size was 6 mm. After removing the right ventricular abnormal myocardium, each edge of the pedicled own pericardium patch was sewn from 5 mm above the pulmonary valve commissures toward the basis of the pulmonary valve ring. The transannular patch was created using a Gore-Tex graft sawn to the right ventricular outflow tract. Echocardiography performed 6 months post surgery showed no pulmonary stenosis and trivial pulmonary insufficiency.

Keywords: Congenital heart disease; Pedicled own pericardium; Pulmonary valve; Tetralogy of Fallot; Transannular patch.