Minimally Invasive ToF Repair in Adult Patient
The operation plan was to perform total repair of ToF through the
left anterior minithoracotomy. The patient was positioned with an
inflatable pillow under the left chest. The anesthesiologist inserted
venous cannula in the right internal jugular vein. The right femoral
artery and vein preparation was made for cardiopulmonary bypass (CPB).
After heparin was given, femoral arterial and venous cannulations were
A 6 cm skin incision was performed over the 4th intercostal space (ICS) from the left sternal border to the left midclavicular line, and the left pleural space was entered through the same ICS.
Before CPB was started, peak between right
ventricle (RV) and left ventricle (LV) pressure ratio was measured. For
better exposure, the authors encircled the ascending aorta with the
tape. The cardioplegia catheter was inserted under direct vision in the
aortic root. The Chitwood cross-clamp was inserted in the second ICS at
the left anterior axillary line. After the aortic cross-clamp was
applied, the cold blood cardioplegic solution with added potassium was
administered with repeat doses at 20–30 minute intervals. At the same
time, a pericardial patch was prepared.
vena cava and superior vena cava were encircled with suture loops for
temporary occlusion. The right atrium was incised and the interatrial
septum was inspected. Right ventriculotomy was made in the RVOT to the
pulmonary valve annulus. The probe with 25 Hegar passed through the
pulmonary artery from the valve. Infundibular stenosis was resected.
Muscle bundles were divided. VSD was exposed and closed through the
transventricular approach using the patch from glutaraldehyde treated
pericardium. The patch was sutured with a continuous 4/0 polypropylene
The aorta was declamped. The RVOT was
closed with a pericardial patch. Cardiopulmonary bypass was discontinued
without inotropic support, and the direct pressure measurements were
performed. The peak RV/LV pressure ratio was measured and revealed no
residual RV outflow tract obstruction. The postoperative transesophageal
echocardiogram showed good results.