Repeat conduit replacement in the pulmonary position without sternal resplitting for the patient with repaired Tetralogy of Fallot and the absent inferior caval vein

Abstract

Recently, sternal reentry has been performed with low perioperative mortality and morbidity. In some patients, however, there are specific problems leading to life-threatening events during sternal reentry. A 27-year-old woman with repaired Tetralogy of Fallot and the absent inferior caval vein was referred to our department for pulmonary conduit replacement. Preoperative computed tomography disclosed the dominant right coronary artery and the ascending aorta longitudinally running just beneath the midline of the sternum. Therefore, we selected bilateral antero-lateral thoracotomy as the alternative approach to avoid the injury of these vital organs. The left axillar and right femoral artery were used for arterial perfusion sites. Venous drainage could be obtained from the left superior caval vein and the isolated hepatic vein via the left antero-lateral thoracotomy, and the right superior caval vein via the right antero-lateral thoracotomy. We successfully performed the repeat conduit replacement via the right antero-lateral thoracotomy.