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Biomedical subjects

C L Backer

Publications and source records attributed to C L Backer.

At least 55 records · Page 3Linked to original sources
PubMed1998

Surgical repair of the congenitally malformed mitral valve in infants and children.

BACKGROUND: Mitral valve remodeling techniques were applied to 26 infants and children (mean age, 6.0 years, range, 0.4 to 15.9 years) with various forms of congenital mitral valve disease over a 7-year period. Patients with atrioventricular canal, L-transposition and single ventricle were excluded. Intraoperative transesophageal echocardiography (TEE) was utilized to assess the repair and guide the need for immediate intervention. METHODS: Twenty-one patients had mitral regurgitation: 10 with cleft anterior mitral leaflet, 7 with annular dilatation, 1 with normal leaflets with an obstructing cord, 2 with prolapsed leaflets and elongated cords, and 1 with restricted leaflet motion, normal papillary muscles, and shortened cords. Of the 5 mitral stenosis patients, 3 had supravalvular mitral ring, 1 had midvalvular mitral ring, and 1 had a parachute valve. Three of the mitral stenosis patients had additional stenotic lesions. Concurrent repair of associated lesions was performed in 21 patients (78%). RESULTS: Operative mortality was 3.8% (n = 1). There were no late deaths. Immediate rerepair in 4 patients resulted in improved function. All mitral stenosis patients improved. A total of 20 mitral regurgitation patients (95%) improved; 1 required mitral valve replacement. Mean follow-up is 31 months (range, 2 to 81 months). All patients are in New York Heart Association functional class I or II. CONCLUSIONS: Mitral valve repair can be successfully performed in infants and children with excellent short- and midterm results. Assessment using transesophageal echocardiography can guide the necessity for immediate rerepair to achieve improved function.

Adolescent↗
PubMed1998

Fontan conversion to cavopulmonary connection and arrhythmia circuit cryoblation.

OBJECTIVES: We review our surgical experience patients with atriopulmonary Fontan operations who had obstructive or arrhythmia indications for conversion to total cavopulmonary artery connections, arrhythmia circuit cryoablation, and placement of atrial antitachycardia pacemaker. METHODS: Fourteen patients (mean age 14 +/- 4 years) had conversion to total cavopulmonary artery connection 8 +/- 3 years after the original atriopulmonary Fontan operation primarily for atrial arrhythmias in 11, obstructive lesions in 2, and bradycardia with cyanosis in 1. Arrhythmia circuit cryoablation was performed on 11 patients and 10 had atrial antitachycardia pacemakers. Preoperative functional New York Heart Association class was IV in 9, III in 4, and II in 1. RESULTS: One patient had brain death (7%) presumably caused by resternotomy complications despite an excellent hemodynamic result. Another required reoperation for a maldeployed clamshell device after attempted fenestration closure. Average length of stay was 10 +/- 3 days; chest tubes were removed on day 7 +/- 3. There were no long-term deaths (mean follow-up 1.7 years, range 5 months to 5 years). Postoperative arrhythmias occurred in five patients, three of whom had successful termination by antitachycardia pacemaker and two who had pharmacologic control of their respective junctional ectopic and slow atrial tachycardia. All patients have improved to New York Heart Association class I or II. CONCLUSIONS: Total cavopulmonary artery conversion in association with arrhythmia circuit cryoablation and atrial antitachycardia pacemaker placement can be accomplished with low morbidity and mortality, oftentimes resulting in dramatic increases in functional class and control of life-threatening arrhythmias.

Adolescent↗
PubMed1998

Repair of congenital tracheal stenosis with a free tracheal autograft.

OBJECTIVES: Evaluate the results of a technique for repair of congenital tracheal stenosis by use of a free tracheal autograft. METHODS: Between January 1996 and July 1997, six infants with congenital tracheal stenosis resulting from complete tracheal rings underwent repair with a free tracheal autograft. Mean age at the time of repair was 4.9 months; mean weight was 5.4 kg. The approach was through a median sternotomy with cardiopulmonary bypass for respiratory support. The trachea was incised anteriorly through the area of stenosis, the midportion of the stenotic trachea was excised, and an end-to-end anastomosis was carried out posteriorly. The excised tracheal segment (1.3 to 2.2 cm long) was used as a free autograft to patch the lower trachea anteriorly. In four infants the autograft was augmented in the upper trachea with pericardium; in two patients with a shorter length of stenosis, the autograft completed the repair. Simultaneous pulmonary artery sling repair (4), ligation and division of patent ductus arteriosus (3), cricoid split (2), atrial and ventricular septal defect repair (1), and complete atrioventricular canal repair (1) were performed at the time of tracheal repair. RESULTS: The infants were extubated and discharged at a mean of 13 and 23 days postoperatively, respectively. One infant had recurrent tracheal stenosis related to the pericardial patch and required a tracheal stent and tracheostomy 4 months postoperatively. Our mean follow-up is 11 months. Bronchoscopic findings currently show widely patent tracheal lumina in all infants. CONCLUSIONS: The technique of free tracheal autograft with and without pericardial augmentation was successful in opening the airway of six infants with congenital tracheal stenosis and is currently our procedure of choice for children with this diagnosis.

Anastomosis, Surgical↗
PubMed1997

Histopathologic changes after pericardial patch tracheoplasty.

Pericardial patch tracheoplasty has been used for surgical correction of long-segment congenital tracheal stenosis caused by complete tracheal rings in infants. The case histories of 2 infants with descriptions of the histopathologic changes in their respective tracheas are presented. Complete reepithelialization of the graft site with ciliated pseudostratified columnar epithelium was found, suggesting the likelihood of normal mucociliary flow in the trachea. The pericardial patches were replaced by mature scar tissue in the graft site, establishing a functional tracheal lumen. Wound healing in the trachea is reviewed. Obstruction by exuberant granulation tissue is an ongoing concern. Pericardium continues to be an important option as graft material for tracheal reconstruction in infants with long-segment congenital tracheal stenosis.

Abnormalities, Multiple↗
PubMed1997

Coronary artery fistulas in infants and children: a surgical review and discussion of coil embolization.

BACKGROUND: Coronary artery fistula (CAF) is a rare congenital anomaly that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of percutaneous transcatheter techniques. The purpose of this article is to review a 28-year surgical experience with CAF as a standard for comparison and to discuss the emergence and efficacy of transcutaneous catheter coil embolization as an alternative form of therapy. METHODS: From 1968 to 1996, 17 patients (age, 6 weeks to 16.5 years; mean age, 5.5 years) were diagnosed with CAF: 8 of 12 by echocardiography and 17 of 17 by cardiac catheterization. All patients with isolated CAF (n = 13) were asymptomatic despite significant clinical, electrocardiographic, and chest roentgenographic findings in 10. Sixteen had congenital CAF and 1 had acquired CAF after tetralogy of Fallot repair with injury of the anomalous left anterior descending coronary artery. Associated anomalies included tetralogy of Fallot (2), atrial septal defect (1), and patent ductus arteriosus (1). Nine fistulas originated from the right coronary artery and eight from the left. Drainage was to the right ventricle (9), right atrium (4), pulmonary artery (3), and left atrium (1). RESULTS: All patients had a median sternotomy with epicardial or endocardial ligation. Cardiopulmonary bypass was used in 8; 1 of these (iatrogenic CAF) required distal internal mammary artery bypass graft. There were no operative or late deaths. Follow-up evaluation by physical examination (17), echocardiography (8), and catheterization (2) showed no evidence of recurrent or residual CAF. A retrospective review of the 16 available cine cardioangiograms showed that coil embolization was possible in, at most, 6 patients. CONCLUSIONS: Early surgical management of CAF is a safe and effective treatment resulting in 100% survival and 100% closure rate. Transcatheter embolization is a reasonable alternative to standard surgical closure in only a very small, select group of patients. These surgical results should be considered the standard against which transcatheter techniques are compared.

Adolescent↗
PubMed1997

Reoperation after pericardial patch tracheoplasty.

Between 1982 and 1995, 28 infants underwent pericardial tracheoplasty for long-segment tracheal stenosis. Seven of these infants required reoperation or stenting for residual or recurrent tracheal or bronchial stenosis. Revisions were performed 2 to 6 months after the original procedure with cardiopulmonary bypass and bronchoscopic guidance. Two patients underwent repeat pericardial patch tracheoplasty, and four patients underwent insertion of a rib cartilage graft. Two of these patients required Palmaz wire expandable stents and one other patient also underwent stent placement. There was one late death 1 year after cartilage graft insertion. The authors identified three risk factors for reoperation after tracheoplasty; younger age at initial surgery and associated pulmonary artery sling or tracheal right upper lobe bronchus. Good intermediate results are possible in this difficult group of children using a selective and inclusive strategy for tracheal enlargement that includes repeat pericardial tracheoplasty, autologous cartilage grafts, and expandable wire stents.

Age Factors↗
PubMed1997

Slide tracheoplasty in the management of congenital tracheal stenosis.

Long-segment congenital tracheal stenosis (LSCTS) is a rare condition. Originally, it was felt to be uniformly fatal; however, advances in technique have made surgical repair and survival possible. Our objective is to report results and technique of slide tracheoplasty for the treatment of LSCTS in the context of the overall experience at the Children's Memorial Hospital in Chicago. We reviewed 37 cases of infants and children with LSCTS. Thirty of the 37 infants underwent surgical intervention. Slide tracheoplasty resulted in survival in 1 of 2 infants, and pericardial patch tracheoplasty resulted in survival in 21 of 28 (75%). Of the 30 patients who had surgical repair, 7 (23%) have died, and 1 has been lost to follow-up (3%). Follow-up has ranged from 6 months to 13 years. Slide tracheoplasty is a satisfactory adjunct to existing techniques. With early diagnosis and appropriate management of LSCTS, survival is possible in a majority of patients.

Anastomosis, Surgical↗
PubMed1997

The two-patch technique for complete atrioventricular canal.

The goals for repairing complete atrioventricular canal (atrioventricular septal defect) are ventricular septation, atrial septation, mitral valve reconstruction, and tricuspid valve reconstruction. Complications to avoid are heart block, residual septal defects, and dysfunctional atrioventricular valves. The surgical repair of atrioventricular canal has undergone major advances over the past 40 years. Excellent short- and long-term results have been achieved with both the single-patch technique and the two-patch technique. The single-patch technique is accomplished by dividing the common valve leaflets into their respective tricuspid and mitral components, suspending them from a single patch used to close the atrial and ventricular septal defects. The two-patch technique uses a prosthetic patch for the ventricular septal defect, a pericardial patch for the atrial septal defect, and suture closure of the anterior mitral cleft. Other variables include the use of deep hypothermia and circulatory arrest, mitral cleft closure, interrupted versus continuous suturing technique, and age at operation. Perhaps more important than the applied method is that the operation be properly executed to ensure defect closure and competent valves. We review our experience in 120 patients using the two-patch technique with special reference to the technical aspects of the operation. The two-patch technique of repair with routine cleft closure as evaluated by intraoperative transesophageal echocardiography results in a low surgical mortality, a low incidence of permanent heart block, and competent atrioventricular valves.

Atrioventricular Node↗
PubMed1996

Double-horned or caplike right ventricle: diagnosis and operative treatment.

BACKGROUND: Three patients reported here and 4 from the literature serve as background for the state-of-art diagnostic and operative considerations for an unusual congenital cardiac malformation: double-horned or caplike right ventricle. METHODS: This is a retrospective analysis of cardiac catheterization, cineangiography, and two-dimensional echocardiography findings, as well as palliative and corrective operations in 3 previously unreported patients. Four patients from the literature are reviewed. RESULTS: Characteristic morphologic features recognizable by invasive and noninvasive imaging distinguish double-horned right ventricle from complex malformations such as criss-cross hearts, superior-inferior ventricles, and univentricular hearts with a small outflow chamber. CONCLUSION: Double-horned or caplike right ventricle is a congenital malformation characterized by an unusual ventricular morphology, which may be the result of incomplete development of the right ventricle. The two-horned appearance may be secondary to an absence of the apical trabeculated compartment, with the left ventricle wedged between the two horns. It is invariably associated with double right ventricular outlet. Surgical experience so far suggest that most patients with typical double-horned right ventricle should be considered for anatomic surgical correction.

Cardiac Catheterization↗
PubMed1996

Taussig-Bing anomaly: arterial switch versus Kawashima intraventricular repair.

BACKGROUND: Current corrective surgical approaches for the Taussig-Bing heart include arterial switch with ventricular septal defect (VSD) closure and intraventricular repair as described by Kawashima. METHODS: Between 1983 and 1994, 20 children underwent intracardiac repair of Taussig-Bing anomaly. Mean age at operation was 17 months (range, 1 week to 9 years). Prior palliation included pulmonary artery band (15) with coarctation repair (8) and atrial septectomy (1). Arterial switch with VSD closure was performed in 16 patients, 10 with anteroposterior great arteries. Kawashima repair was performed in 4 patients, all with side-by-side great arteries. RESULTS: After arterial switch, there was one operative death (6.2%) due to myocardial ischemia and three late deaths (18.7%) due to pulmonary hypertension, gastrointestinal bleeding, and acute lymphocytic leukemia. In the Kawashima repair group there have been no deaths. After arterial switch, 9 patients underwent 11 reoperations for residual coarctation (3), residual pulmonary artery stenosis (2), aortic valve replacement, aortic valvuloplasty, unrecognized VSD, mitral valvuloplasty, mediastinitis, and pacemaker insertion. After Kawashima repair, 1 patient underwent reoperation for baffle stenosis and 1 for an unrecognized VSD. CONCLUSIONS: For children with Taussig-Bing anomaly, the Kawashima intraventricular repair (for side-by-side great arteries) preserves the native aortic valve and avoids coronary dissection. The arterial switch operation with VSD closure can be applied without ventriculotomy to all great artery relationships and allows neonatal repair with or without concomitant coarctation repair. Both techniques yield excellent early and intermediate-term results despite the high rates of prerepair palliation and postrepair reoperation for both groups.

Aortic Coarctation↗
PubMed1996

Expanding indications for pediatric coronary artery bypass.

Pediatric coronary artery bypass has been done mostly for ischemic complications of Kawasaki disease. We reviewed our clinical experience between 1987 and 1994 with internal thoracic artery-coronary artery bypass in one infant and five children for varying indications. Indications for coronary bypass included Kawasaki disease (2), congenital left main coronary ostial stenosis, iatrogenic coronary cameral fistula, anomalous origin of the left coronary artery from the pulmonary artery, and single coronary artery traversing between the great arteries in a patient after cardiac transplantation. An additional cohort of 34 control patients of various ages and weights (1 day to 16.1 years, 2.6 kg to 62 kg) had angiographic measurements of the right coronary, left coronary, and left internal thoracic arteries with respect to the feasibility of performing coronary artery bypass. All six patients survived internal thoracic artery-left anterior descending coronary artery bypass without evidence of perioperative myocardial infarction. Postoperative angiographic studies in five and color Doppler echocardiography in one showed graft patency. Retrospective angiographic measurements in the 34 control patients showed that internal thoracic and coronary arteries are proportionately quite large in neonates and infants compared with those in older children and adolescents. Internal thoracic artery-coronary artery bypass should be considered for the expanding indications presented herein and when emergency intraoperative life-threatening situations present themselves. Long-term patency and reoperation rates have yet to be determined.

Case-Control Studies↗
PubMed1996

Diltiazem preserves direct vasodilator response but fails to suppress intimal proliferation in rat allograft coronary artery disease.

BACKGROUND: We investigated the effect of diltiazem on transplant coronary artery disease in rat cardiac allografts both with standard histologic techniques and by measuring coronary vascular resistance and vasodilator response of the coronary arteries. METHODS: Hearts from Lewis rats were transplanted into Fischer 344 rats in an abdominal position without immunosuppression as a chronic rejection model. The rats were randomly divided into two groups: (1) no drug intervention (control; n = 36) and (2) diltiazem in drinking water (n = 33). Syngeneic transplants, Lewis donor to Lewis recipient, were used for isograft comparison (n = 17). Rat allografts were observed for length of survival, and at 4 months the surviving allografts were transferred to Langendorff perfusion, where coronary vascular resistance and its response to acetylcholine and nitroglycerin were examined. Allografts were also examined histologically and assigned transplant coronary artery disease and cellular rejection grades. RESULTS: Graft survival at 4 months was 43%, 38%, and 100% in control, diltiazem, and isograft groups, respectively. In the control group baseline coronary vascular resistance was much higher than in isografts (243 +/- 52 versus 35.3 +/- 6.2 cm H2O center dot gm center dot min/ml, p < 0.05) and the response to acetylcholine and nitroglycerin was significantly lower than that in the isografts (acetylcholine 6.2% +/- 4.8% versus 16.4% +/- 3.3%, p < 0.05; nitroglycerin 5.6% +/- 4.7% versus 12.6% +/- 5.7%, p < 0.05). In the diltiazem group baseline coronary vascular resistance (191 +/- 72 cm H2O center dot gm center dot min/ml) and the response to acetylcholine (7.3% +/- 2.9%) were similar to those in the control group (p = not significant); however, the response to nitroglycerin was better than that in the control group and in fact similar to that in the isograft group (13.6% +/- 7.0%; p < 0.05 versus control group, p = not significant versus isograft group). Histologic examination showed no coronary artery disease in isografts but equivalent marked transplant coronary artery disease and inflammation in both the control (transplant coronary artery disease grade 2.9 +/- 0.6, cellular rejection grade 3.6 +/- 0.7) and diltiazem (transplant coronary artery disease grade 3.0 +/- 0.8, cellular rejection grade 4.3 +/- 0.9) groups. CONCLUSION: In this transplant coronary artery disease model, diltiazem did not suppress the development of coronary intimal proliferation, but it did help preserve the vasodilative properties of the allograft coronary arteries in response to nitroglycerin, a direct vasodilator.

Animals↗
PubMed1995

Coarctation of the aorta. Repair with polytetrafluoroethylene patch aortoplasty.

BACKGROUND: The first successful surgical repair of coarctation of the aorta (CoAo) was performed in 1944, but during the years that followed a high incidence of recoarctation was seen, ranging from 20% to 86%. In response to that problem, the patch aortoplasty was introduced in 1957; however, true aneurysms were found in the aortic wall opposite the patch after Dacron patch aortoplasty, particularly when the coarctation ridge was excised. The purpose of our review was to evaluate the results of patch aortoplasty for CoAo using a relatively new material, polytetrafluoroethylene (PTFE), and an operative technique that does not involve resection of the coarctation ridge. METHODS AND RESULTS: Between 1979 and 1993, 125 infants and children underwent PTFE patch aortoplasty for CoAo; 111 of the procedures were primary repairs, and 14 were reoperations. Diagnoses were isolated CoAo (96 patients), CoAo and ventricular septal defect (15 patients), and CoAo with complex intracardiac anomaly (14 patients). Patient age at the time of repair ranged from 4 days to 17 years (mean age, 5.1 +/- 4.5 years). There were no instances of intraoperative mortality or paraplegia. There were 4 deaths from 10 to 40 days postoperatively, all in neonates (mean age, 33 days) who received additional intracardiac procedures for complex associated anomalies. Follow-up has ranged from 6 months to 12.5 years (mean, 4.5 +/- 3.2 years). All children had postoperative chest roentgenograms, 80 (66%) patients have had a postoperative echocardiogram and 16 (13%) a cardiac catheterization. One patient had successful repair of a false aneurysm 4 months postoperatively. No patient has developed a late true aneurysm. Of the patients < 1 month of age at the time of CoAo repair (12 patients), 6 patients had recurrent CoAo (gradient > 20 mm Hg) compared with only 4 recurrences in 97 patients > 1 month of age at the time of repair (P < .001). CONCLUSIONS: For children > 1 year of age, PTFE patch aortoplasty remains our procedure of choice for CoAo repair because of the low mortality rate, low recoarctation rate, and absence of late true aneurysms. We have stopped using this technique for infants < 1 month of age because of the high recurrence rate.

Adolescent↗
PubMed1995

Characterization of inwardly rectifying K+ channel in human cardiac myocytes. Alterations in channel behavior in myocytes isolated from patients with idiopathic dilated cardiomyopathy.

BACKGROUND: Little is known about the characteristics of the inwardly rectifying K+ channel (IK1) and the influence of preexisting heart disease on the channel properties in the human heart. METHODS AND RESULTS: We studied the characteristics of cardiac IK1 in freshly isolated adult human atrial and ventricular myocytes by using the patch-clamp technique. Specimens were obtained from the atria and ventricles of 48 patients undergoing cardiac surgery or transplantation and from four explanted donor hearts. The action potential in ventricular myocytes exhibited a longer duration (391.4 +/- 30.2 milliseconds at 90% repolarization, n = 10) than in atrium (289.4 +/- 23.0 milliseconds, n = 18, P < .001) and had a fast late repolarization phase (phase 3). The final phase of repolarization in ventricle was frequency independent. Whole-cell IK1 in ventricle exhibited greater slope conductance (84.0 +/- 7.9 nS at the reversal potential, EK; n = 27) than in atrium (9.7 +/- 1.2 nS at EK; n = 8, P < .001). The steady-state current-voltage (I-V) relation in ventricular IK1 demonstrated inward rectification with a region of negative slope. This negative slope region was not prominent in atrial IK1. The macroscopic currents were blocked by Ba2+ and Cs+. The channel characteristics in ventricular myocytes from patients with congestive heart failure after idiopathic dilated cardiomyopathy (DCM) exhibited distinct properties compared with those from patients with ischemic cardiomyopathy (ICM). The action potential in ventricular myocytes from patients with DCM had a longer duration (490.8 +/- 24.5 milliseconds, n = 11) compared with that for ICM (420.6 +/- 29.6 milliseconds, n = 11, P < .01) and had a slow repolarization phase (phase 3) with a low resting membrane potential. The whole-cell current slope conductance for DCM was smaller (41.2 +/- 9.0 nS at EK, n = 7) than that for ICM (80.7 +/- 17.0 nS, n = 6, P < .05). In single-channel recordings from cell-attached patches, ventricular IK1 channels had characteristics similar to those of atrial IK1; channel openings occurred in long-lasting bursts with similar conductance and gating kinetics. In contrast, the percent of patches in which IK1 channels were found was 34.7% (25 of 72) of patches in atrium and 88.6% (31 of 35) of patches in ventricle. Single IK1 channel activity for DCM exhibited frequent long-lasting bursts separated by brief interburst intervals at every holding voltage with the open probability displaying little voltage sensitivity (approximately 0.6). Channel activity was observed in 56.2% (18 of 32) of patches for DCM and 77.4% (24 of 31) of patches for ICM. Similar results were obtained from atrial IK1 channels for DCM. In addition, channel characteristics were not significantly different between ICM and explanted donor hearts (donors). IK1 channels in cat and guinea pig had characteristics virtually similar to those of humans, with the exception of lower open probability than that in humans. CONCLUSIONS: These results suggest that the electrophysiological characteristics of human atrial and ventricular IK1 channels were similar to those of other mammalian hearts, with the possible exception that the channel open probability in humans may be higher, that the whole-cell IK1 density is higher in human ventricle than in atrium, and that IK1 channels in patients with DCM exhibited electrophysiological properties distinct from IK1 channels found in patients with ICM and in donors.

Action Potentials↗
PubMed1995

Coarctation of the abdominal aorta.

Four patients with suprarenal coarctation of the abdominal aorta were managed from 1978 to 1993 (mean follow-up 8.75 years). Ages at the time of diagnosis were 2 months, 8 months, 4.5 years, and 15 years, respectively. Three children presented with severe hypertension, two of whom were in congestive heart failure, and the fourth child presented with a cold, ischemic leg. The 8-month-old patient had Williams syndrome (supravalvular aortic and pulmonic stenosis, bilateral renal artery stenosis and celiac artery occlusion, "elfin" facies, and mental retardation) and was treated nonoperatively. After 12 years of follow-up, he was given five medications to control hypertension, cardiac arrhythmias, and heart failure. Three patients with abdominal aortic coarctation were treated operatively and none died. Two patients underwent bypass grafting from the supraceliac aorta to the infrarenal aorta, with bilateral renal artery reconstruction in one. Postoperative arteriograms obtained 1 year or more after operation were normal in both cases. The 2-month-old patient underwent patch aortoplasty, with subsequent reoperation 1.5 years later for recurrent hypertension and heart failure with a bypass graft to the left kidney and removal of an infarcted right kidney. In all three patients, operative repair of the suprarenal aortic coarctation has resulted in long-term control of blood pressure and cardiac and renal function.

Adolescent↗
PubMed1995

Tetralogy of Fallot with anomalous origin of the right coronary artery.

This report describes a child with tetralogy of Fallot and acquired pulmonary valve atresia in whom the pulmonary blood flow was provided solely by retrograde flow from an anomalous right coronary artery originating from the main pulmonary artery. Complete repair with preservation of the native pulmonary valve and implantation of the right coronary artery into the ascending aorta is described.

Child↗