Surgical creation of a double outlet right atrium for tricuspid valve stenosis after a Rastelli operation.

A patient with transposition of the great arteries, ventricular septal defect, and obstruction of the left ventricular outflow tract underwent a Rastelli repair. Stenosis of the tricuspid valve was not recognised before or during operation; this severely compromised the postoperative haemodynamic function and necessitated reoperation. Insertion of a second homograft from the right atrium to the right ventricle bypassed the stenosis and resulted in a complete recovery with maintenance of a biventricular circulation.