Tetralogy of Fallot with single coronary artery and pulmonary thromboembolism in a 7-year-old child: surgical management and technical considerations

A 7-year-old cyanotic child with unrepaired tetralogy of Fallot, a single coronary artery arising from the left coronary sinus, and suspected pulmonary thromboembolism underwent complete intracardiac repair. This video tutorial demonstrates a comprehensive surgical strategy that simultaneously addresses intracardiac repair and pulmonary thromboendarterectomy while safely managing a rare coronary anomaly. Following median sternotomy and establishment of cardiopulmonary bypass, the pulmonary arteries were carefully inspected because preoperative imaging suggested thrombotic material within the pulmonary artery. Pulmonary arteriotomy revealed organized thromboembolic material, which was meticulously removed, restoring pulmonary arterial patency. Attention was then directed to correction of the congenital cardiac defect. The large malaligned ventricular septal defect was closed with a polyester patch through the right atrial approach. Severe right ventricular outflow tract obstruction caused by infundibular and valvular pulmonary stenosis was relieved by extensive muscle resection and pulmonary valvotomy.