Extracardiac conduit replacement with autologous tissue only, via a left anterior small thoracotomy

A 13-year-old boy, who had undergone a Rastelli procedure 8 years before, d eveloped severe extracardiac conduit stenosis and infectious endocarditis. Sternal re-entry appeared to be dangerous and to require extensive adhesiol ysis. Through a left anterior small thoracotomy, however, good exposure was obtained and the operation was performed safely and much less invasively. The main pulmonary artery was reconstructed with autologous tissues only, i .e. fibrous tissue bed and broadly based pericardial pedicle. There was no residual stenosis. The patient convalesced rapidly.