Tetralogy of Fallot Repair: How I Teach It

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Presentation transcript:

Tetralogy of Fallot Repair: How I Teach It Richard D. Mainwaring, MD, Frank L. Hanley, MD The Annals of Thoracic Surgery Volume 102, Issue 6, Pages 1776-1781 (December 2016) DOI: 10.1016/j.athoracsur.2016.09.111 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Artist’s illustration demonstrating tetralogy of Fallot with a normal-size pulmonary valve and annulus. (Adapted from [6], by permission of The Society of Thoracic Surgeons.) The Annals of Thoracic Surgery 2016 102, 1776-1781DOI: (10.1016/j.athoracsur.2016.09.111) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Tetralogy of Fallot with hypoplastic main pulmonary artery and small (bicuspid) pulmonary valve and annulus. An incision is made in the main pulmonary artery. (B) The pulmonary valve is sized with a metal dilator. (C) Commissurotomies are performed. (Adapted from [6], by permission of The Society of Thoracic Surgeons.) The Annals of Thoracic Surgery 2016 102, 1776-1781DOI: (10.1016/j.athoracsur.2016.09.111) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) An infundibulotomy is performed. (B) Commissurotomies are extended. (C) The valve annulus is sized and gently dilated under direct vision. (Adapted from [6], by permission of The Society of Thoracic Surgeons.) The Annals of Thoracic Surgery 2016 102, 1776-1781DOI: (10.1016/j.athoracsur.2016.09.111) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) The anterior commissure is split with a scalpel. (B) The incision is extended to join the infundibulotomy. (C) A transannular patch is sutured in place. (D) The transannular patch is narrowed with a series of clips. (Adapted from [6], by permission of The Society of Thoracic Surgeons.) The Annals of Thoracic Surgery 2016 102, 1776-1781DOI: (10.1016/j.athoracsur.2016.09.111) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) Tetralogy of Fallot with a bicuspid pulmonary valve and commissures located at 10 o’clock and 4 o’clock. An incision has been made on the main pulmonary artery. (B) A counterincision has been made on the infundibulum. (C) The incision is curved to split precisely through the commissure. (Adapted from [6], by permission of The Society of Thoracic Surgeons.) The Annals of Thoracic Surgery 2016 102, 1776-1781DOI: (10.1016/j.athoracsur.2016.09.111) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions