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.