Slicing technique of the RV outflow tract in transatrial-transpulmonary repair for tetralogy of Fallot

The relief of a right ventricular outflow tract obstruction is a crucial step to successful transatrial-transpulmonary repair for tetralogy of Fallot. We here describe our technique for achieving good effective relief of a right ventricular outflow tract obstruction by slicing the wall without right ventriculotomy or with minimum transanular right ventriculotomy if necessary. The right ventricular outflow tract can be widely opened by slicing the inner half of the wall both through the tricuspid valve and the pulmonary valve. This procedure can be performed safely and effectively by detecting structural differences between the inner and outer half of the right ventricular wall, the former coarse and the latter dense.