Extracardiac conduit replacement with autologous tissue only, via a left anterior small thoracotomy

A 13-year-old boy, who had undergone a Rastelli procedure 8 years before, developed severe extracardiac conduit stenosis and infectious endocarditis. Sternal re-entry appeared to be dangerous and to require extensive adhesiolysis. Through a left anterior small thoracotomy, however, good exposure was obtained and the operation was performed safely and much less invasively. The main pulmonary artery was reconstructed with autologous tissues only, i.e. fibrous tissue bed and broadly based pericardial pedicle. There was no residual stenosis. The patient convalesced rapidly.