The surgical anatomy of the pulmonary artery root in relation to the pulmonary valve autograft and surgery of the right ventricular outflow tract

The anatomy of the septal perforating arteries in normal and congenitally malformed hearts

“…These include ventricular dysfunction, arrhythmias, and sudden death. 1,6,[10][11][12][13][14] Our study has shown that landmarks do exist to permit the surgeon to determine where in the septum, if necessary, incisions can be made and where sutures can be placed without damaging the first septal perforating artery.…”

“…In the normal heart the perforating arteries arise from the 2 major epicardial arteries that delimit the location of the muscular ventricular septum. [1][2][3] These are the so-called anterior and posterior descending arteries, although in reality their interrelationships are more accurately described as superior and inferior. In hearts with 1 dominant and 1 incomplete and hypoplastic ventricle, the comparable epicardial arteries are better described as "delimiting" arteries.…”

“…Nonetheless, damage to these vessels can result in myocardial damage and arrhythmias. 1 In this study, therefore, we sought to establish landmarks to permit the prediction of the precise origin and distribution of the septal perforating arteries in normal and congenitally malformed hearts.…”

The Ross Procedure

“…In 1970 the results of the first 84 and 97 patients were published 7 . In 1971, Geens et al 8 studied the anatomic relationships between the coronary arteries and the pulmonary root, establishing critical points for autograft extraction.…”

Morbidity Following the Ross Operation

“…Excision of the pulmonary valve was then performed taking care not to injure the blood supply of the ventricular septum. 9 Continuity between the right ventricle and distal main pulmonary artery was attained by interposing a fresh antibiotic sterilized aortic homograft conduit. 5 After trimming the excess right ventricular muscle, scalloping the longer edge of the pulmonary conduit, the autologous pulmonary valve (which had been preserved in the pericardium with blood drained from the coronary perfusion cannulas) was inserted with the standard two suture lines originally described by Ross 1 o and Barratt-Boyes 11 for the insertion of freehand homograft valves in the subcoronary position.…”