3:10 PM - 5:40 PM
[SEV-07] 外科卒業後教育ビデオセッション
Repair of Tetralogy of Fallot with Hypoplastic Infundibulum and Pulmonary Valve
In a subset of tetralogy of Fallot (TOF) patients, the pulmonary valve (PV) annulus and the infundibulum are hypoplastic, and they need to be patch-augmented. In these patients the right ventricular outflow tract (RVOT) cannot be enlarged by muscle resection, because muscular hypertrophy is not the underlying anatomic problem. Only a transannular patch (TAP) extended to the infundibulum can completely relief the RVOT obstruction.
In this video I present such a case of TOF repair. The patient is a 3 month-old boy weighing 6.5 kg.
Standard bicaval and aortic cannulation is performed and moderate hypothermic cardiopulmonary bypass is started. Stitches are placed in the infundibulum and PV annulus to mark the anticipated extension of the TAP. After aortic X-clamping, the right atrium (RA) is opened and the ventricular septal defect (VSD) and RVOT are explored through the tricuspid valve. The VSD is closed with a pericardial patch in a running fashion. A longitudinal incision is then performed in the pulmonary trunk, and it is extended to the RVOT. A pericardial patch is trimmed on a Hegar dilator, to match the desired RVOT diameter, and it is sewn in place. RA is closed, leaving open the foramen ovale. X-clamp is removed, rewarming is completed and the patient is weaned off bypass. Modified ultrafiltration is performed. By direct punction we get right ventricle (RV) pressures at 50% of systemic ones.
Postoperative course was characterized by mild RV failure with an intensive care unit and total stay of 6 and 12 days, respectively.
In this video I present such a case of TOF repair. The patient is a 3 month-old boy weighing 6.5 kg.
Standard bicaval and aortic cannulation is performed and moderate hypothermic cardiopulmonary bypass is started. Stitches are placed in the infundibulum and PV annulus to mark the anticipated extension of the TAP. After aortic X-clamping, the right atrium (RA) is opened and the ventricular septal defect (VSD) and RVOT are explored through the tricuspid valve. The VSD is closed with a pericardial patch in a running fashion. A longitudinal incision is then performed in the pulmonary trunk, and it is extended to the RVOT. A pericardial patch is trimmed on a Hegar dilator, to match the desired RVOT diameter, and it is sewn in place. RA is closed, leaving open the foramen ovale. X-clamp is removed, rewarming is completed and the patient is weaned off bypass. Modified ultrafiltration is performed. By direct punction we get right ventricle (RV) pressures at 50% of systemic ones.
Postoperative course was characterized by mild RV failure with an intensive care unit and total stay of 6 and 12 days, respectively.