Techniques for repair of tetralogy of fallot with pulmonary atresia using homografts: The Rotterdam Experience

Tetralogy of Fallot with pulmonary atresia (PA) comprises absence of functional continuity between the right ventricle and the pulmonary arterial tree, ventricular septal defect (VSD), and overriding of the aorta and right ventricular hypertrophy. In this setting the pulmonary blood flow may be supplied by the ductus arteriosus or by systemic-pulmonary collateral arteries (SPCA’s) (3). In patients with a well developed pulmonary arterial system, treatment mostly consists of initial palliation with a modified Blalock-Taussig shunt and later complete repair (7). On the other hand, the presence of SPCA’s is often associated with a diminutive central pulmonary arterial system (7). In this setting early and preferably complete unifocalization is necessary to attain an adequate pulmonary arterial system and to avoid imbalances of pulmonary vascular resistance. In both settings, the complete repair concerns closure of the VSD and establishment of the right ventricular-pulmonary arterial continuity with closure of previously constructed shunts. At present, the pulmonary homograft appears to be the conduit of choice for reconstruction of the right ventricular outflow tract (1, 2, 9).