Tetralogy of Fallot
This heart defect arises from displacement of the infundibulum septum towards the right and the front. The result is a ventricular septal defect, overriding aorta, right ventricular outflow stenosis and hypertrophy of the right ventricle.
Access is by median sternotomy. Transtricuspidally the VSD is closed with the use of a patch (Dacron) and several single button sutures. Depending on the position of the ventricular defect, access via the pulmonary valve or the right ventricular outflow tract (RVOT) may be selected. Depending on the diameter of the RVOT and the pulmonary arteries, resection of muscle bundles may make transannular patch enlargement of the RVOT of the pulmonary valve, reaching into the left pulmonary artery, necessary. The ductus is transected.