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OBJECTIVES The prevention of pulmonary insufficiency (PI) is a crucial part of the tetralogy of Fallot repair. Many techniques have been introduced to construct valves from different materials for the right ventricular outflow tract, including the most commonly constructed monocusp valves. We are introducing a new bicuspid valve made intraoperatively using the autologous right atrial appendage (RAA) to prevent PI in these patients. METHODS The RAA valve was constructed and used in 21 patients with tetralogy of Fallot. The effective preservation of the native valve was impossible in all patients because of either a severe valve deformity or a small annulus. The RAA valve was created after ventricular septal defect closure and right ventricular outflow tract myectomy and was covered with a bovine transannular pericardial patch. The perioperative data were evaluated, and the echocardiography results were assessed immediately after operations and in follow-up with a median of 10.5 months. The data were retrospectively compared with 10 other patients with similar demographic data but with only transannular patches. RESULTS The mean age of the patients was 13.3 months. No mortality or related morbidity occurred after repair using the RAA valve. The PI severity early after the operation was trivial or no PI in 18 patients, and mild PI was observed in 3 patients, which progressed to moderate PI in one of them in the mean 12-month follow-up period. Fifteen patients had mild or no pulmonary stenosis, while moderate pulmonary stenosis was observed in 6 others. Compared with the other 10 patients with only transannular patches, the RAA valve patients had prolonged operative and clamping times, but no difference in postoperative course and shorter hospital stays. The degree of PI was, of course, significantly less in the RAA valve patients, but pulmonary stenosis was the same. CONCLUSIONS The RAA valve construction is a safe and effective technique to prevent PI after the tetralogy of Fallot repair, at least in terms of short- and mid-term results. A longer follow-up period is needed to confirm if this new valve can eliminate or significantly delay the need for pulmonary valve replacement in these patients.

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Background Several surgical techniques have been proposed to repair right partial anomalous pulmonary venous connection (PAPVC) along with sinus venosus defect (SVD). This study aimed to compare the perioperative data and outcomes of double‐patch repair using a minimally invasive approach versus conventional sternotomy in pediatric and adult patients. Methods This retrospective study was conducted on 48 minimally invasive cases and 35 sternotomy cases, undergoing surgery by a single surgeon between July 2002 and August 2020. For all patients, repair was performed using the double‐patch technique. In the minimally invasive approach, right mini‐thoracotomy was performed with central cannulation for children and with peripheral cannulation for adults. The patients were classified into two pediatric and adult groups, and each group was categorized into minimally invasive and sternotomy approaches. They were followed‐up by transthoracic echocardiography and electrocardiography before and early after surgery, 3 and 6 months after surgery, and then annually. The relative data were compared between the two approaches in terms of perioperative findings, postoperative pulmonary vein or superior vena cava (SVC) stenosis, and sinus node dysfunction. Results This study included 25 minimally invasive cases and 19 sternotomy cases in the pediatric group (mean age, 4.99 ± 4.28 and 6.10 ± 4.39 years, respectively) and 23 minimally invasive cases and 16 sternotomy cases in the adult group (mean age, 35.73 ± 8.06 and 32.62 ± 9.80 years, respectively). The mean and median follow‐ups were 6.31 ± 4.92 years and 6 years (range: 6 month−18 year) in the pediatric group and 6.15 ± 4.53 years and 5 years (range: 6 month−18 year) in the adult group, respectively. The mean chest tube drainage was significantly lower in the minimally invasive pediatric group (p = .03), and the mean blood transfusion volume was significantly lower in the minimally invasive adult group compared to the other groups (p = .03). No stenosis occurred in the pulmonary veins. Mild SVC stenosis occurred in one patient in the minimally invasive pediatric group, with no need for reintervention. All patients had a normal sinus rhythm, except for the mentioned case with a transient, first‐degree atrioventricular block, which spontaneously reverted to the normal sinus rhythm. Conclusions The minimally invasive approach can be a safe and practical alternative for the double‐patch repair of PAPVC and SVD. It ensures a repair with comparable quality to sternotomy, but with better cosmetic and psychological outcomes.

Objectives: TOF is the most common cyanotic CHD. We investigated left ventricular (LV) function after surgical pulmonary valve replacement (sPVR) in patients with repaired Tetralogy of Fallot (rTOF) by Speckle Tracking Echocardiography (STE).Methods: 58 volunteers participated in this study who divided into 3 groups including 22 PVR patients (mean age 18.96±7 year), 16 repaired Tetralogy of Fallot and 20 healthy age match control. For all patients, we performed 2D echocardiography and STE.Results: 2D echocardiography in all groups showed normal LV ejection fraction without a significant statistical difference (64% sPVR, 60% in repaired Tetralogy of Fallot and 62.5% in the control group). However, the mean global longitudinal strains (GLS) of LV were significantly reduced in both sPVR (-17.5±2.5%) and repaired Tetralogy of Fallot (-17.1±4.7%) patients rather than control group (-20.2±0.7%) (P = 0.003). But GLS had no statistically significant difference between repaired Tetralogy of Fallot and sPVR patients (P=0.9). Segmental analysis of longitudinal strain (LS) showed a significant decrease in sPVR patients and repaired Tetralogy of Fallot group in basal anterior, basal septal, basal anterolateral segments, mid-anterior and anterolateral segments. Except for lower LS in the apical-anteroseptal segment, this level was mostly spared in both sPVR and repaired Tetralogy of Fallot patients.Conclusion: LVEF was within normal range after sPVR patients, but the pattern of impaired segmental LS and GLS did not change as compared with rTOF. Surgical PVR in patients with repaired TOF may not have a significant effect on the improvement of LV function assessed by STE. LV damage which happens during surgical correction of TOF may have a permanent deteriorating effect on LV function.