Primary repair minimizing the use of conduits in neonates and infants withtetralogy or double-outlet right ventricle and anomalous coronary arteries

Objective: The purpose of this study was to review our results with an appr oach of early primary repair for tetralogy of Fallot or double-outlet right ventricle with anomalous coronary arteries, using several techniques to mi nimize the use of a conduit. Methods: Twenty consecutive neonates and infan ts with anomalous coronary arteries crossing an obstructed right ventricula r outflow tract underwent primary repair. Median age was 5.5 months and mea n weight 6.22 kg. The anomalous coronary arteries included the left anterio r descending from the right coronary artery (n = 10), the right coronary ar tery from the left anterior descending (n = 1), the left anterior descendin g from the right sinus (n = 1), and a significant conal branch from the rig ht coronary artery (n = 7) or left anterior descending (n = 1), Two neonate s had pulmonary atresia, The right ventricular outflow tract was reconstruc ted without a conduit in 18 patients, including those with pulmonary atresi a, Surgical techniques included main pulmonary artery translocation in 4 pa tients, transannular repair under a mobilized left anterior descending coro nary artery in 2 patients, and displaced ventriculotomy with subcoronary su ture lines in 8 patients. In 4 patients the right ventricular outflow tract was repaired via the ventriculotomy and/or pulmonary arteriotomy, A homogr aft was used as the sole right ventricle-pulmonary artery connection in I p atient and in another a homograft was added to a hypoplastic native pathway . Results: There have been no early or late deaths. The right ventricular/l eft ventricular pressure ratio within 48 hours of the operation was 0.47 +/ - 0.10, There were 2 reoperations at 8 and 11 years after the operation, du ring a mean follow-up of 5.2 years (1-11.3 years). Conclusions: Primary rep air of tetralogy of Fallot or double-outlet right ventricle with anomalous coronary arteries can be done in neonates and infants with excellent result s. Alternative surgical techniques for right ventricular outflow tract reco nstruction, such as main pulmonary artery translocation, can avoid the use of a conduit in most patients.