Tetralogy of Fallot With Ebstein’s Anomaly Correction in a Neonate

Originally presented as a STSA/CTSNet Surgical Motion Picture at the 2016 STSA Annual Meeting. 

Objectives: A 3.7 kg 27-day-old male baby was diagnosed with Tetralogy of Fallot with Ebstein’s anomaly. The initial presentations were respiratory distress and hypotension. Cyanosis was also noted after his PDA closure. The authors present the surgical technique to repair this rare and severe anomaly.

Methods: Under standard cardiopulmonary bypass, the authors performed tricuspid valve reconstruction via both right ventricular outflow tract and right atrial approach. The tricuspid valve was displaced downward towards the apex and right ventricular outflow tract. The anterior leaflet was attached on the free wall of right ventricle and at the lower edge of the ventricular septal defect. The posterior leaflet was the only movable part. The authors detached and mobilized the tricuspid valve. Reattachment of the valve to the normal position of tricuspid annulus was performed. The VSD was repaired with Dacron patch after myomectomy, and right ventricular outflow tract was reconstructed with autologous pericardial patch. The ASD was closed partially with a small fenestration.

Results: Postoperative echo showed mild tricuspid regurgitation without residual VSD or RVOT stenosis. The post-operative course was smooth. After extubation on the postoperative day 14, the SpO2 was around 90% ~ 95% under room air without signs of heart failure.

Conclusion: The authors performed total correction of Tetralogy of Fallot with anomaly and pulmonary stenosis in a neonate. The postoperative course was quite good. Early repair for this rare and severe anomaly is feasible.

Copyright 2016, used with permission from the Southern Thoracic Surgical Association. All rights reserved.