Introduction: The currently available options for restoring right ventricle (RV) to pulmonary artery (PA) continuity are far from satisfactory. In absence of an ideal conduit, hand sewn bovine pericardial conduit with Polytetrafluroethylene (PTFE) tri-leaflet valve (BPCTV) may serve as a satisfactory alternative particularly in low and middle income countries (LMIC). Material and Methods: The hospital records of all patients who received BPCTV in RV to PA position from January 2014 to June 2019 were retrospectively analysed. A total of 41 patients were further classified into two groups; pulmonary hypertension group (PH) and non-pulmonary hypertension group (NPH). The primary endpoints of the study were mortality, and freedom from re-operation for conduit failure. The secondary end point was to study the impact of pulmonary hypertension on the conduit function and durability. Results: The Mean age and weight of patients at time of conduit implantation was 56.8 months (range 2-196 months) and 12.3 kg (range 3-44 kg) respectively. The mean size of conduit was 18 mm (range 12-24 mm). The mean duration of follow up was 30 months (range 8-72 months). The freedom from re-intervention was 86% at 30 months (range 8-72 months). The cost of BPCTV was less than one-sixth of the commercially available bovine jugular vein conduit. Conclusion: The hand sewn BPCTV is a cost effective alternative to commercially available conduits with acceptable outcomes. However, more research with a larger sample size and a longer follow-up is required.
The incidence of unusual coronary patterns including single coronary artery is high in Taussig-Bing anomaly (TBA). The relocation of a single coronary artery from a non-facing sinus can be technically challenging with implications on early and late outcomes. Many innovative techniques for coronary transfer have been described and no coronary pattern precludes arterial switch operation in the current era. We describe a technique of coronary transfer using autologous pericardial tube extension with good early outcome.
We present an unusual combination of lesions in an eight months old child diagnosed with Tetralogy of Fallot (TOF), Anomalous origin of Right Pulmonary artery (AORPA) and anomalous coronary artery (ACA) crossing the pulmonary annulus. The association of AOPA and TOF is extremely rare with an incidence of 0.4%. (1) The incidence of anomalous coronary artery in TOF is 10.3%. (3) However a combination of all three lesions poses challenges to surgical repair and has not been previously reported.