Repair of Tetralogy of Fallot With Absent Pulmonary Valve and Nonconfluent Left Pulmonary Artery

Tetralogy of Fallot with absent pulmonary valve and a nonconfluent left pulmonary artery is an uncommon combination usually associated with respiratory distress due to tracheobronchial compression by the aneurysmally dilated right pulmonary artery. Although application of the conventional technique is not feasible for this subset of patients, our novel "spiral plication" technique, wherein both the anterior and posterior walls of the dilated right pulmonary artery are resected in a spindle shape and plicated as if it is squeezed spirally, provides effective release of the obstructed airway concomitant with reconstruction of the left pulmonary artery confluence with growth potential.