Late Follow-Up of Rastelli Operation After One-Stage Repair with Right Ventricular Remodeling

Abstract

We report long-term outcomes after one-stage, surgical repair, at an 11-year-old, girl with pulmonary atresia with a ventricular septal defect and anomalous origin of the left coronary artery from the right coronary artery, crossing the right ventricular outflow tract. The operation was carried out with the remodeling of the right ventricle, using a swine valved conduit prosthesis (22mm). Twenty-nine years later, the patient is in excellent clinical condition, CF I (NYHA), with normal peripheral oxygen saturation. Recent invasive and not invasive imaging show: the absence of intracardiac shunt, despite presenting prosthesis calcification and signs of mild double lesion of the prosthetic valve. The pulmonary flow is directed uniformly for both lungs. Patients undergoing the implantation of valved conduits during childhood, present mismatch, after a few years of follow-up, and are required to undergo frequent reoperations. In this patient, the indication of a Blalock-Taussig shunt, during childhood, allowed to postpone the surgery and implant a valved conduit with a larger diameter, achieving a long follow-up with a single prosthetic implant.