A New Technique of Transannular Monocusp Patch-Repair of the Right Ventricular Outflow Tract in Repair of Tetralogy of Fallot

Reconstruction of the right ventricular outflow tract (RVOT) is a key procedure in repair of Tetralogy of Fallot (TOF). The procedure creates pulmonary insufficiency (PI) that may compromise the right ventricular (RV) function, particularly during late follow-up. A simple way to reduce PI is to create a monocusp patch from xenografts, homografts, fascia lata, and autologous pulmonary artery or pericardium. Each of those has limitations. The autologous pericardial valve sewn on another pericardial patch is one of the earliest monocusp patches used clinically but loses anti-PI effect soon after the operation presumably due to degeneration or absorption of the monocusp. I have therefore designed and used a new technique (folded monocusp patch) to create a monocusp for TOF repair in children and adults. The technique has been used in nine patients of the 18 TOF patients who needed transannular patch-repair in total 74 TOF repairs. The monocusp patch-repaired patients had minimal or mild PI and good RV function beyond 8–12 months. The long-term results await follow-up and further study in multi-institutions.