Early experience with surgical strategies aimed at preserving the pulmonary valve and annulus during repair of tetralogy of Fallot.

INTRODUCTION In recent years there has been a trend towards repair of tetralogy of fallot (TOF) during early infancy with good outcomes.[ 1 , 2 , 3 , 4 , 5 , 6 , 7 ] Majority of the surgeons do the repair with a transannular patch (TAP) in the right ventricular outflow tract (RVOT).[ 1 , 2 ] When a TAP is done, the structural integrity of the valve and the annulus is lost and this leads to pulmonary regurgitation and the long-term consequence of progressive right ventricular dilatation.[ 8 , 9 , 10 ] To avoid pulmonary regurgitation, there has been an increasing trend to preserve the native pulmonary valve (PV) and avoid incising the annulus and preserve its integrity.[ 11 , 12 , 13 , 14 , 15 , 16 ] Intraoperative balloon dilatation of the annulus/valve ring has been concomitantly employed as part of the repair technique to preserve the annulus.[ 11 , 12 , 17 , 18 ] More recently, delamination plasty of the PV cusps has been introduced as part of the valve-sparing strategy.[ 11 , 12 , 19 ] In this manuscript, we present our early experience with valve and annulus sparing repair of TOF.

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