A Technique For Pulmonary Artery Reduction For The Repair Of Tetralogy Of Fallot With Absent PulmonaryValve William Patrick, MD1, Max Mitchell, MD2, Matthew Stone, MD, PhD1. 1Childrens Hospital of Colorado, Aurora, CO, USA, 2HCA HealthONE Rocky Mountain Children's, Denver, CO, USA.
Introduction The objective of neonatal surgery for Tetralogy of Fallot with absent pulmonary valve (TOF/APV) is to alleviate compression of airways. We present a video of our technique of a posterior pulmonary artery reductionplasty and LeCompte maneuver without division of the aorta. Description A 2.5kg newborn with TOF/APV required intubation shortly after. The patient underwent surgery at four days old. After cooling to 24C and arresting the heart the main pulmonary artery (PA) was transected. Orienting sutures were placed on the proximal branch pulmonary arteries and they were divided. A triangular wedge of tissue was resected from the posterior wall of each branch PA. The posterior wall of each PA was re-approximated and confirmed to be at least 5mm. A LeCompte maneuver was achieved by re-anastomosis the branch PAs anterior the aorta. The VSD was closed and RV-PA conduit constructed with pulmonary homograft. Post-operative evaluation demonstrated relief of airway compression and the patient was extubated on post operative day four. There were no complications. Conclusion The most common approach to pulmonary artery reduction in TOF/APV is an anterior reductionplasty and LeCompte maneuver involving transection of the aorta. We believe that a posterior excision reductionplasty and LeCompte maneuver without aortic transection offers the optimal repair by maximizing the distance from the airway to the posterior wall of the pulmonary arteries and avoiding foreshortening of the ascending aorta, which can compress the airway. The technique shown here is safe, effective, and easily adopted.
