Reconstruction of right ventricular outflow tract with a valved conduit in 75 cases of congenital heart disease.

Reconstruction of the right ventricular outflow tract with an aortic homograft conduit was performed in 75 patients from 1966 to 1974. The types of congenital heart disease were as follows: pulmonary atresia, 35 cases; severe tetralogy of Fallot, 22 cases; truncus arteriosus, 6 cases; transposition of the great arteries (TGA), 3 cases; single ventricle, 2 cases; and tricuspid atresia, 7 cases. Ninety per cent of the patients had one or more previous shunts, and this was a factor affecting the mortality rate. Other factors included age, pulmonary vascular resistance, surgical anatomy, and technical problems such as bleeding, prolonged bypass, coronary artery injury, and compression of the conduit by the sternum. Our present approach is to avoid shunts, define the anatomy precisely by angiography, and to attempt total correction when severe hypoxia or effort intolerance occurs or before increased pulmonary vascular resistance develops.