PH implantation:
The PH was implanted by full sternotomy. Cardiopulmonary bypass (CPB) was established between standard aortic cannulation and selective venous cannulation of the superior and inferior vena cava. A left ventricle vent was inserted through the right superior pulmonary vein and surgery was performed in normothermia during CPB. PH was implanted under CPB and beating heart or with aortic cross clamping. Myocardial protection was provided by a warm blood cardioplegia injected every 10 min in child, every 20 min adult. First time of the surgery was the large resection of the RVOT, with the pulmonary valve and part of the right ventricular infundibulum. The pulmonary infundibulum was calibrated to the PH size, if necessary with the implantation of an autologous pericardial patch or with a Dacron® patch prosthesis. The PH was inserted and sutured to the pulmonary infundibulum and the pulmonary artery by continuous suture. More recently, a Dacron® tube prosthesis has been interposed between the pulmonary infundibulum and the PH if necessary. This maneuver helps to maintain a perfect sphericity of the PH. The distal anastomosis of the PH was sometimes associated with a pulmonary artery enlargement in case of pulmonary arteries stenosis.