In the unusual case in which the anulus is adequate a valvotomy alone using sharp dissection opening the three identifiable commissures is all that is performed. The arteriotomy is subsequently closed with a running absorbable suture. In the more usual case inspection of the valve will reveal inadequate valve tissue and anulus, and the longitudinal arteriotomy incision will be taken across the anulus onto the right ventricular muscle. This incision is extended proximally until a clear opening into the right ventricular cavity is established. For critical neonatal pulmonary stenosis Surgical relief of critical pulmonary stenosis is indicated in several circumstances.
Exposure is obtained by a median sternotomy.
The thymus is mobilized but not removed and a longitudinal pericardiotomy is performed. The patient should be placed on cardiopulmonary bypass by cannulating the aorta and the right atrial appendage using a warm calcium-supplemented blood prime to allow continuous cardiac activity. Core temperature may be maintained at normothermic levels or allowed to drift only. At the institution of bypass the arterial duct is temporarily occluded with a snare. Active core cooling and aortic cross-clamping with or without cardioplegia should be avoided.