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What are the Techniques of rastelli operations ?
After median sternotomy pericardial patch is harvested and then cardiopulmonary bypass instituted using aortic and bicaval cannulation. The pulmonary trunk, bifurcation and branches are dissected and freed from aorta. After cooling down to moderate hypothermia aorta is clamped and cold cardioplegia given into the aortic root. Left side of the heart is vented through the right superior pulmonary vein or through atrial septum.
A para coronary, vertical light ventriculotomy is done and anatomy evaluated. VSD may be large and subarterial. If the size of VSD is small it has to be enlarged anterolaterally to avoid heart block. If the tricuspid valve chordae are crossing, they have to be cut and reattached to the VSD patch. A Goretex (PTFE) or polyester (Dacron) patch that is large and properly cut is used as an intra ventricular tunnel to close the VSD. It will direct the flow from LV under the patch to the aortic oiifice. Pulmonary ately is transacted and its proximal part doubly sutured. The distal part of the pulmonary at-tery is anastornosed to the distal end of allograft or prosthetic graft. The conduit is then placed on the left side of the aorta and its proximal end is anastomosed to the right ventriculotomy incision. Pericardial patch is used to augment the allograft conduit at its proximal end.
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