Bicuspid Pulmonary Valve Neocuspidization Using Ozaki Technique in Infants With Tetralogy of Fallot With Absent Pulmonary Valve Syndrome-Feasibility and Early Experience.

BackgroundTetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) presents significant surgical challenges in infants due to airway compression from dilated branch pulmonary arteries. Surgery typically involves closing the ventricular septal defect (VSD) and reducing the size of the pulmonary arteries to relieve airway compression. A competent pulmonary valve is especially beneficial in these cases. We describe creating an Ozaki pulmonary valve using native pericardium for this condition.Material and MethodsFour infants (median age 4.8 months [IQR 4.3-5.4], median weight 3.5 kg [IQR 2.0-5.0]) presented with respiratory distress and were diagnosed with TOF-APVS. The presence of bronchial compression was confirmed with computed tomography of the thorax. All patients underwent total intracardiac repair, including closure of the VSD, the Lecompte maneuver, reduction of the enlarged pulmonary arteries, and bicuspid pulmonary valve reconstruction using glutaraldehyde-treated pericardium with the Ozaki technique. Postoperative transesophageal echocardiogram confirmed well-functioning pulmonary valves with minimal pressure gradients. Each patient recovered uneventfully, was discharged, and is doing well on follow-up.ConclusionThe Ozaki technique facilitates precise and symmetric reconstruction of the bicuspid pulmonary valve in cases of TOF-APVS, demonstrating encouraging early results for infants, particularly in resource-limited environments.