There is a wide spectrum of severity in tetralogy of Fallot, ranging from minimal pulmonary obstruction, to severe pulmonary obstruction or even absence of the pulmonary valve. Therefore in each case, the type of surgical repair is targeted to the individual child's cardiac anatomy. That being said, the use of conduits is less common than doing a transannular patch or a limited right ventricular outflow patch and pulmonary valvotomy. In all cases there is a large ventricular septal defect (sometimes multiple); in addition there can be atrial level holes, coronary anomalies, leakage of the aortic valve and lung artery abnormalities that also need to be addressed. In all cases, the VSD is closed and muscle bundles in the right ventricular outflow tract are removed. Conduits are tubes that are placed to connect the right ventricle to the lung artery branches. Conduits have to be up-sized as a child grows, so unless absolutely necessary we prefer not to use them. The indications for a conduit include pulmonary valve absence (atresia) or an abnormal course of a coronary artery across the right ventricular outflow tract that prohibits the surgeon from doing a transannular patch (might injure the coronary artery). Hope this helpsanswer your questions.
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