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Transannual Patch Repair of Tetralogy of Fallot

Institution: University of Arkansas for Medical Sciences

Authors:

Thomas Heye – teheye@uams.edu

Lawrence Greiten MD – lgreiten@uams.edu

Christian Eisenring ACNP-BC -EisenringC@archildrens.org

The patient was prepped and draped in normal sterile fashion. Midline sternotomy was created and divided with oscillating saw. The thymus was then resected, and a pericardial well created. Heparin was administered and circulated, followed by aortic and bicaval cannulation. After initiating cardiopulmonary bypass the patient was cooled to 32 degrees Celsius. After ensuring typical LAD anatomy, marking suture were placed on the right ventriculotomy site with 5-0 Prolene. Next, an LV vent was inserted into the right upper pulmonary vein and connected to suction. This was followed by antegrade cardioplegia application once cross clamp was initiated. The previously marked right ventriculotomy site was then opened with a 15 blade scalpel and extended with Metzenbaum scissors across the infundibulum, through dysplastic pulmonary valve into the main pulmonary artery. A right ventricular outflow tract muscle bundle was identified and sharply incised. This allowed direct exposure of the anterior misaligned VSD. Cormatrix was brought to the field, sized accordingly, and sutured with 6-0 Prolene with a continuous technique. Prior to tying the patch down, several breaths were provided to allow the lungs to de-air. Rewarming was then began while an additional Cormatrix patch was brought to the field and sized accordingly. The patch was sown onto the infundibulum with 5-0 Prolene. The patient was then placed in steep Trendelenburg position. The root was vented through the cardioplega site, and caval snares released. Several large breaths were given and the cross-clamp released. Patient was then weaned from cardiopulmonary bypass and decannulated following administration of Protamine. Temporary ventricular and atrial pacing wires were placed, brought through the skin, and secured. A 20-French anterior mediastinal chest tube was then place via stab incision and secured. After ensuring hemostasis, patient was closed in the typical fashion.
Tetralogy of Fallot
Repair can be delayed until the post-neonatal period if the RVOT is not severe and medically managed
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Residual Lesions Low Cardiac Outpute Cardiopulmonary Arrest Arrhythmia Heart Block Bleeding PA branch stenosis
none
Doyle T, Kavanaugh-McHugh A, and Fish F. (2019). Management and outcome of tetralogy of Fallot. In T.W. Post, P. Rutgeerts, & S. Grover (Eds.), UptoDate. Available from: https://www.uptodate.com/contents/management-and-outcome-of-tetralogy-of-fallot
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