Right Ventricular Outflow Tract Reconstruction With Contegra Bovine Valved Conduit

11-year-old boy affected by truncus arteriosus (type 1) underwent a late complete repair in another insti- tution. The right ventricular outflow tract reconstruction was performed with an 18-mm Contegra conduit (Medtronic Inc, Minneapolis, Minn) despite its contrain- dication in cases of pulmonary hypertension. An additional apical muscular ventricular septal defect was closed with a percutaneous device. His postoperative course was uneventful. At 18 years of age, he was referred to our institution for right ventricular dilatation and conduit endocarditis. A group D streptococcus was isolated on blood culture. Echocardiography and cardiac catheterization showed right ventricular dilatation, isosystemic right ventricular pressure, and aneurysmal dilatation of the conduit extend- ing from the ventricular anastomosis. Computed tomogra- phy confirmed the angiographic findings, recording a giant aneurysm of the conduit (7.439.5910.26 cm) (Figure 1). This required urgent conduit replacement with a 25-mm Hancock (Figure 2). After surgery, a left lung atelectasia occurred. Vascular lesions may obstruct the bronchial tubes by compression. Chronic compression may result in malacic changes on the deformed cartilages. In our case, severe malacia for extrinsic compression of the left main bronchus appeared after the aneurysm was removed. Four days after the original operation, a silicon bronchial stent was success- fully positioned to relieve bronchial malacia. The anatomic relationship between the main left bron- chus and the new conduit was studied through angiography and simultaneous bronchography (Figure 3 and Movie in the online Data Supplement). The patient then underwent extubation and was dismissed on postoperative day 25. Surgical correction of a variety of congenital right ventricular outflow tract anomalies requires interposition of a valved conduit to reestablish continuity between the right ventricle and the pulmonary artery bifurcation. The Contegra bioprosthesis consists of a heterologous bovine jugular vein with an incorporated trileaflet venous valve and natural sinus. This conduit has shown good biocom- patibility and excellent hemodynamic properties. Contegra is extremely pliable and available in various sizes (from 12 to 22 mm), making it suitable for implantation from early infancy to adulthood.