Pulmonary valve cusp augmentation with autologous pericardium may improve early outcome for tetralogy of Fallot

A, Pulmonary cusp augmentation repair technique. A transannular incision has been created according to calibration of the RVOT diameter (see text). The incision divides the anterior pulmonary valve leaflet, although the exact location will vary with the valve orientation and morphology. B, Pulmonary cusp augmentation repair technique. A triangular patch of glutaraldehyde-preserved autologous pericardium is sutured to the epicardial edge of the RVOT incision and to the divided edges of the valve leaflet. The leaflet dimensions are based on the caliber of a normal pulmonary valve diameter and should provide sufficient free edge diameter to ensure coaptation with the native valve remnant. C, Pulmonary cusp augmentation repair technique. A second larger oval patch of the same material is sutured to the epicardial aspect of the RVOT incision and to the edges of the pulmonary arteriotomy, creating a sinus anterior to the reconstructed leaflet. PA, Pulmonary artery; PV, pulmonary valve; RVOT, right ventricular outflow tract.