Damus-Ratelli Procedure for Double Outlet Right Ventricle With Doubly-Committed Subarterial Ventricular Septal Defect

To prevent interventricular rerouting tunnel obstruction after biventricular repair for double outlet right ventricle, it is essential to create a sufficiently straight and wide interventricular rerouting. In cases of the ventricular septal defect extending under both semilunar valves arranged side by side and perpendicular to the outlet septum, conventional rerouting to one semilunar valve may obstruct the other. Herein, we describe our technique for creating an interventricular rerouting tunnel in this rare anatomical configuration by combining rerouting from ventricular septal defect to both semilunar valves and Damus anastomosis. Upon completion, the Rastelli procedure without a conduit was performed.