Rastelli procedure

Rastelli procedure

Rastelli procedure was initially designed for the repair of d-transposition of great arteries (d-TGA) with ventricular septal defect and pulmonary stenosis. Later it has been used for other conditions with two ventricles, overriding aorta and pulmonary stenosis or atresia. Rastelli procedure can be used for the repair of pulmonary atresia with ventricular septal defect and double outlet right ventricle (DORV) with pulmonary stenosis.

Rastelli procedure involves excision of the obstructive muscle in the right ventricular outflow tract, suturing an intraventricular baffle connecting the left ventricle to the aorta and closing the ventricular septal defect. The right ventricle is connected to the pulmonary artery by a valved homograft conduit. The procedure is done under cardiopulmonary bypass, preferably under transesophageal echo guidance. It is an extensive procedure requiring moderate to long cardiopulmonary bypass time. Post operative inotropic support may be needed. Close monitoring and management of postoperative arrhythmias are also needed.