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.