The 'Rastelli' operation--results at the Singapore General Hospital

Reconstruction of the right ventricular outflow tract in patients with right ventricle-pulmonary artery discontinuity with a valved conduit is well established. The aim of this study was to review our results at the Singapore General Hospital. Between October 1989 and May 1993, 13 patients underwent the 'Rastelli' operation. The mean age at definitive repair was 68 months. Ten patients had pulmonary atresia with ventricular septal defect, two patients truncus arteriosus (one patient each with type 3 and type 2) and one patient had tetralogy of Fallot with absent pulmonary valve syndrome. In 12 patients cryo-preserved pulmonary artery homografts with a mean diameter of 21mm (19-23mm) were used, and a 11mm composite Hancock dacron valved conduit in one patient. There were no operative deaths. The mean duration of follow-up is 37 months (23-48 months). All patients were well and in NYHA class I on recent follow-up. On echocardiographic assessment 12 patients had trivial or no gradient across the right ventricular outflow tract, while one patient had a gradient of 25mmHg. The "Rastelli" operation can be undertaken with low mortality and morbidity and early results are encouraging.