Reconstruction of the right ventricular outflow tract: short-term solutions, long-term problems

There is no reliable, durable valve conduit for reconstruction of the right ventricular outflow tract in conditions such as Fallot’s tetralogy, pulmonary atresia, truncus arteriosus and for pulmon-ary valve replacement after the Ross procedure for aortic valve replacement. All the reconstructions available provide short-term unobstructed flow with no pulmonary incompetence but in the medium- to long-term there is the development of either right ventricular outflow tract obstruction and/or severe pulmonary incompetence. Currently, the answer to these problems is reo-peration with pulmonary valve replacement, usually at an open operation or in some cases with a transcatheter-mounted valve placed in the right ventricular outflow tract. Historically pulmonary or aortic homografts have been the mainstay of valve replacement in the right ventricular outflow tract, either as valves or as conduits. Various animal-derive