Pulmonary valve-sparing technique in patient with tetralogy of Fallot and anomalous coronary artery crossing the infundibulum.

A 15-month-old girl who presented at birth with tetralogy of Fallot and was followed after an echocardiographic diagnosis of an anomalous origin of the right coronary artery from the left anterior descending coronary artery, crossing the right ventricular infundibulum very close to the pulmonary valve annulus, was scheduled for repair. At surgery, after routine trans-atrial/trans-pulmonary repair, the pulmonary valve (PV) was balloon-dilated through the right ventricular outflow tract (RVOT) up to a 'normal size' PV annulus, based on the patient's body surface area. Two-dimensional echocardiography at discharge revealed an adequate relief of the RVOT obstruction, with a normal-sized PV annulus and a competent PV. In this subset of patients, this technique can be considered an additional surgical strategy to avoid the use of conduits.