Surgical treatment of right ventricular outflow tract obstruction after Tetralogy of Fallot repair

Situs solitus of viscera and atria, D-looped ventricle with atrioventricular concordance, and inverted normally related great arteries with ventriculoarterial concordance characterize the segmental anatomy of an extremely rare {S,D,I} variant of Tetralogy of Fallot. The main pulmonary artery is rightward of the aorta and the right coronary artery crosses over the right ventricular outflow tract from left to right to reach the right atrioventricular groove. Our patient had undergone a neonatal repair due to persistent cyanosis with the implantation of a pericardial infundibular patch after the diagnosis of Tetralogy of Fallot {S,D,I}. He presented with an annular right ventricular outflow tract obstruction at 19 months of age. We describe the surgical approach employing a transannular patch implantation for the relief of the annular right ventricular outflow tract obstruction.