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Gianfranco Butera, Raul Abella, Mario Carminati, Alessandro Frigiola, Perventricular implantation of a right ventricular-to-pulmonary artery ‘conduit’, European Heart Journal, Volume 30, Issue 17, September 2009, Page 2078, https://doi.org/10.1093/eurheartj/ehp227
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Extract
A 2.2 kg newborn who underwent a cardiac catheterization at 2 days of life showed pulmonary atresia, ventricular septal defect, and confluent pulmonary arteries of 2.5 mm in diameter and a Nakata of 50 mm/m2. Pulmonary arteries were supplied from a major aorto pulmonary collateral from the left subclavean artery (Panel A). Oxygen saturation was around 60%. Surgical options (implantation of a modified Blalock–Taussig shunt or of a right ventricular outflow tract conduit) were considered too risky. A hybrid approach was undertaken under general anaesthesia and oro-tracheal intubation. Patient underwent midline sternotomy. Under direct vision and by using a 21-gauge needle, the free wall of the right ventricle was punctured and the cannula directed towards the atretic right ventricular outflow tract (RVOT) and towards the small pulmonary artery trunk (Panel B).
A 0.021 in., 21 cm long standard guidewire was advanced and then a 5 Fr paediatric sheath was placed over that wire through the atretic RVOT and the pulmonary trunk (Panels C and D).