Minimally Invasive ToF Repair in 2-Month-Old Child

We are presenting the case of the minimally invasive total repair of Tetralogy of Fallot in a 2-month-old male patient.

Echocardiography showed good LV contractility, open permanent ductus arteriosus (PDA), open permanent foramen ovale (PFO), large ventricular septal defect (VSD), severe infundibular stenosis and hypoplastic main pulmonary artery (PA) and PA branches
Our operation plan was: Right axillary minithoracotomy in 4th intercostal space; Thymectomy; Central cardiopulmonary bypass (CPB) cannulation; PDA closure; Aortic cross-clamp and cardioplegia administration; Trans-atrial VSD closure with glutaraldehyde treated auto-pericardial patch; PFO closure; Trans-annular right ventricular outflow tract (RVOT) and PA repair with auto-pericardial patch closure.

For the right axillary access patient had been rotated on the left lateral decubitus position. Horizontal skin incision was made over the 4th intercostal space between anterior and posterior axillary lines. Large thymus was excised. After pericardiotomy, cannulation for cardiopulmonary bypass was performed. Cannula for IVC was inserted through the additional small incision in the 6th ICS. The PDA was defined and closed. Aortic cross-clamp had been applied, antegrade cold blood cardioplegia administered.

Closure of the VSD was performed through the TV using glutaraldehyde treated auto-pericardial patch. No leaflets detachment was performed.

PFO was closed using polypropylene 5/0.

The main pulmonary artery incision was extended onto the right ventricular outflow tract across the pulmonary valve annulus for 1cm. Left and right pulmonary arteries were passed with a 6 mm Hegar. Muscle bundles of RVOT obstruction were divided. Trans-annular auto-pericardial patch closure was sutured with polypropylene 6/0.

Aorta was unclamped. Heart restored beating in sinus rhythm. Staged decannulation was performed after achieving satisfactory hemodynamics. Wound was closed in layers with nice cosmetic results.

The intraoperative echocardiography was done and no residual ventricular septal defect and no residual RVOT obstruction was confirmed.

The duration of the operation time was 330 min, CPB time - 207 min. Aorta had been cross-clamped for 115 min.

The patient’s postoperative course was unremarkable. He was staying in the intensive care unit for 2 days. Patient was discharged from the hospital on the 7th postoperative day.

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