Simplified double barrel repair with autologous pericardium for tetralogy of fallot with hypoplastic pulmonary annulus and anomalous coronary crossing right ventricular outflow

Tetralogy of Fallot with coronary crossing the right ventricular outflow tract: A tale of a bridge and the artery

A coronary artery crossing the right ventricular outflow tract is a subset of a larger pathomorphological cohort known as an anomalous coronary artery (ACA) in the tetralogy of Fallot (TOF). The best possible outcome in a patient with TOF and ACA is decided by judicious selection of optimum preoperative investigative information, the timing of surgery, astute assessment of preoperative surgical findings, and appropriate surgical technique from a wide array of choices. In most instances, the choice of surgical technique is determined by the size of the pulmonary annulus and the anatomical relation of ACA to the pulmonary annulus. In the present era, complete, accurate preoperative diagnosis and primary repair is a routine procedure with strategies to avoid a right ventricle-to-pulmonary artery conduit.

Tetralogy of Fallot correction with transannular patch reconstruction in a patient with an anomalous right coronary artery and an unusual course of the right ventricular branch

Anomalous coronary arteries occur in as many as 12% of patients with tetralogy of Fallot (TOF). In patients with this condition, pulmonary hypoplasia can be prohibitive in performing a valve-sparing repair, subsequently resulting in various techniques to preserve the anomalous coronary artery. The management strategy is often complex in such a situation. We report on a case of TOF with an anomalous right coronary artery crossing the right ventricular outflow tract, with an unusual course of the right ventricular (RV) branch, which precluded placement of a valved conduit. In this case, we performed a successful repair with mobilization of the anomalous coronary artery and reconstruction of the right ventricular outflow tract with a limited transannular patch.

Double-barrel right ventricular outflow: tetralogy of Fallot annulus preservation technique

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.