Single-Strip Pericardium Technique for Pulmonary Valve Reconstruction in Tetralogy of Fallot: A Case Report

Right ventricular outflow tract (RVOT) dysfunction requiring pulmonary valve reconstruction following the surgical repair of Tetralogy of Fallot (ToF) is common. It remains a challenge in the pediatric population due to the small size of the pulmonary valve annulus, especially when the pulmonary valve is still growing in size. The use of monocusp valves and xenograft valved conduits tend to have long-term functional limitations arise over time, leading to early valve re-reconstruction or re-replacement. Studies reported the use of the Ozaki technique to reconstruct the pulmonary valve to overcome this problem. However, our centre did not have access to the equipments needed for the Ozaki procedure. We had an 8-year-old with ToF who was scheduled for total correction of ToF. However, after exposing the RVOT, we found that the pulmonary valves have fused and retracted bicuspid leaflets. We decided to reconstruct the pulmonary valve using a single strip of autologous pericardium. Postoperative transesophageal echocardiography showed mild pulmonary stenosis with a gradient of 33 mmHg without pulmonary regurgitation, as well as good neo pulmonary leaflet motion and coaptation. The patient was discharged without any complications. With this technique, we can create three equal-sized leaflets without the need of any special equipment and still achieve physiological valve hemodynamics while being more economic, easily reproducible, and much simpler to shorten bypass time. If required, the procedure can also be done together with a trans-annular patch in the correction of ToF.