Technique for Neo-Pulmonary Valve Creation With Living Tissue for Repair of Atrioventricular Septal Defect and Tetralogy of Fallot

Abstract

Long-standing effects of pulmonary regurgitation after transannular patch repair in Tetralogy of Fallot (ToF) can be especially deleterious in the setting of combined ToF and complete atrioventricular septal defect (CAVSD). We present a technique for a complete repair of combined ToF/CAVSD using right atrial appendage tissue to create a competent neo-pulmonary valve. This technique provides advantages of right heart protection via pulmonary valve competence and the use of living tissue capable of growth with the patient, potentially obviating the need for repeat interventions.

Creation of a Neo-Mitral Valve With Right Atrial Appendage Tissue in an Infant

“…The tip of the RAA was amputated to create a cylinder with a length of 13-mm, matching the distance we had measured between the mitral annulus and the heads of the papillary muscles. We also removed most of the intraluminal trabeculations as previously described 5 (Figures 1 and 2). An atrial transseptal approach was utilized.…”

“…Previously, CorMatrix or bovine or equine pericardium has been used to construct the “cylinder valve,” 1,2,6 although the lack of regenerative potential and possibility of inflammatory reaction have been recognized. We decided to use the RAA due to our previous experience with using it as a pulmonary valve substitute 5,7 as well as partial aortic valve reconstruction. Theoretically, there would be no inflammatory reaction since it is all autologous material, and it may have growth potential.…”