Total correction of tetralogy of fallot with pulmonary artery and valve hypoplasia using autologous pericardial patch and bovine pericardium patch augmentation: A case report

Tetralogy of Fallot (TOF) with pulmonary artery and valve hypoplasia presents a significant surgical challenge, especially in late presentations. Surgical repair must be tailored to optimise both anatomical correction and long-term vascular function. Here we report the case of a 16-year-old girl with uncorrected TOF who presented with exertional cyanosis and dyspnea. Imaging revealed severe hypoplasia of the main pulmonary artery (MPA), right pulmonary artery (RPA), and pulmonary valve (PV). Surgical correction involved transannular incision with autologous pericardial patch (APP) augmentation of the RPA and bovine pericardium (BP) augmentation of the MPA and PV reconstruction. A size-21 monocusp BP valve was used to restore valve competence. The patient's postoperative course was smooth, with minimal bleeding, no complications, and a rapid recovery. The patient was discharged within two days, and follow-up showed no evidence of restenosis or recurrence of hypoplasia. This case report supports the combined use of APP and BP for TOF patients with complex pulmonary anatomy, demonstrating excellent biocompatibility, adaptability to patient-specific vascular anatomy, and good mid-term outcomes. In resource-limited settings, biologic patch use may offer durable, cost-effective alternatives to synthetic grafts, especially in delayed presentations.