Surgical Procedure
Except for one patient (Case 8) who refused surgical treatment due to combined with left diaphragmatic eventration and severe restrictive ventilatory disorder, 7 patients underwent surgery.
All 7 patients underwent bilateral pulmonary artery reconstruction. Different surgeons have chosen different surgical strategies and techniques. Three patients underwent one-stage TOF correction with bilateral pulmonary artery reconstruction (Case 3, Case 6, and Case 7). Three patients underwent bilateral pulmonary artery reconstruction as the first intervention, followed by two-stage TOF correction after several months (Case 1, Case 2, and Case 4). One patient underwent 2 procedures of left pulmonary artery reconstruction, and the VSD remained open currently (Case 5). See Table 2 for the detail of the operations.
The Goretex vessel was used to reconstruct the left pulmonary artery in 3 patients (Case 1, Case 4 and Case 5). In 2 patients, the posterior wall of the left pulmonary artery was directly anastomosed with the main pulmonary artery, and the anterior wall was widened by a pericardial patch (Case 2 and Case 3). In the other 2 patients, a modified technique was applied: a U-shaped vascular wall was cut from the left side of the main pulmonary artery, turned over and anastomosed with the posterior wall of the left pulmonary artery, and the anterior wall was widened with an autologous fresh pericardial patch (Case 6 and Case 7). The sketch of the modified procedure is shown in Figure 2.
TOF repair is in accordance with classic technical specifications: pericardium patch repairs ventricular septal defect; Transannular patch or non-transannular patch (the pulmonary artery and right ventricular outflow tract were widened respectively) according to the development of pulmonary valve annulus. Patients with coronary artery crossing the right ventricular outflow tract used a tube sewed with autologous pericardium to connect the main pulmonary and right ventricular outlet tract.