Replacement of right ventricle to pulmonary artery and right atrium to right ventricle homograft after a modified Rastelli operation.

The patient, a 17 year old boy, had undergone a Rastelli operation for transposition of the great arteries plus ventricular septal defect and left ventricular outflow tract obstruction at the age of 7 years. Associated tricuspid valve stenosis was treated with insertion of a second homograft shortly after the Rastelli operation. The patient remained symptom-free for 10 years, when he suffered femoral artery embolus. Investigation showed severe obstruction of both conduits and biventricular dysfunction with thrombus in the left ventricle. After embolectomy and stabilisation of his general condition and prolonged treatment with heparin, he underwent uneventful replacement of the two conduits. He remains well, 8 months after the operation.