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Designed by cardiac surgeon Giancarlo Rastelli, the Rastelli procedure is an operation used to correct a variety of different heart defects present at birth. These defects include the anatomical flip flopping of the aorta and the pulmonary artery, a hole in the ventricular wall, and blockage in the flow of blood from the right ventricle. During the procedure, the ventricular hole is plugged, the obstruction in the right ventricle is removed, and the aorta and pulmonary artery are reoriented using a donor graft. This procedure has a relatively low rate of mortality.
One of the several congenital heart defects restored by the Rastelli procedure is dextro-transpostition of the great arteries. This heart flaw occurs when the pulmonary artery and the aorta are flip flopped. The Rastelli procedure also corrects a ventricular septal defect, or hole within the septum or wall between the right and left ventricle. This surgical procedure also mends a right ventricular outflow obstruction. In this condition, the drainage from the left or right ventricle is plugged.
All of these conditions are congenital defects of the heart, or cardiac problems present at birth. If not corrected early, the baby may not survive. The Rastelli procedure is usually performed between the ages of one and two years old.
This cardiac operation is fairly complex, requiring some basic understanding of how the heart works. The heart is divided into four parts. At the top of the heart are the left and right atria, separated by a septum. On the bottom of the heart are the left and right ventricles, also separated by a septum. Oxygenated blood enters the left atrium via the pulmonary veins and flows into the left ventricle and then out to the body through the aorta.
Oxygen-depleted blood returns from the body and enters the heart through the superior and inferior vena cava. The blood then flows through the right atrium and then into the right ventricle. Finally, the deoxygenated blood passes through the pulmonary artery on its way to the lungs, where it is oxygenated. The atria and ventricles act as powerful pumps circulating the blood around the heart and out to the body.
During the Rastelli procedure, a small opening is made in the right ventricle so that the surgeon can look for the hole in the ventricular septum. Once located, the hole is plugged using excised ventricular muscle tissue, which is stitched in place over the ventricular fissure. The excised ventricular muscle tissue may be taken from the part of the ventricular outflow that is plugged, thereby opening the ventricular outflow into the aorta. Finally, during this procedure, a donor tissue graft is used to connect the flow of blood between the right ventricular and the pulmonary artery.