Hybrid procedure for acute severe aortic regurgitation in an uncorrected adult tetralogy of Fallot.

Adult survivors of surgically uncorrected complex tetralogy of Fallot [TOF] with multiple aorto-pulmonary coronary arteries [MAPCAs] are unusual and the development of severe aortic regurgitation [AR] due to endocarditis is a rare and difficult problem to manage. We report a successful hybrid approach utilising temporary balloon occlusion of the collaterals during the cross-clamp time as a strategy to allow adequate brain perfusion and safe aortic root replacement.