XC. Cardioplegia. Snare the SVC. Wait for the heart to arrest (or continue while snaring the IVC, opening RA fully, and PFO (with 11 blade or right angle to stretch) to vent). Stop cardioplegia, snare the IVC and open the RA. Once open, continue cardioplegia. Open the RA parallel to the AV groove. Table tilted to the left.

Place one ticron stay on the right side (sutured to pericardium or as a stay, and two on the left side of the RA incision. Place the sucker in the PFO or make an ASD in the fossa to place the sucker. Huck towels on both sides.

Examine the tricuspid valve. Use two small langenbecks (with large ends in the valve) and the small sucker to probe the IVS.

First stitch interrupted pledgetted 5/0 (or 6/0 in small babies) premio (half-circle) outside in through the edge of the base of the septal leaflet coming out below the valve in the same chordal space to avoid catching the chordae. And secure them on the right side with shods (with the ends separated), that will provide some retraction, and better visualisation. Place another two pairs of stitches on either side and shod them on your side. Take the dacron sauvage and

Take another horizontal mattress stitch halfway at the bottom of the VSD on to the patch. Secure with a knot and put one needle on the shod and come up on the superior part in a continuous manner going radially on the patch. The stitches are on the right side of the VSD away from the crest. Use a nerve hook to tighten the running stitch if necessary. Use additional sutures if necessary. Do the same for the other half of the VSD. Rewarm.

Bring the ends of both stitches under the tricuspid valve. Additional base of leaflet stitch if needed. Tie all the sutures (2 x valve stitches and 2 x running stitches to the valve stitches). Use assistant to retract the leaflet away from the knots.

Reattach any papillary muscles (6/0 prolene pledgetted). Test the tricuspid valve.

Take a mattress stitch in the IAS, blows on the lungs, deair the left side, tie it down. Connect the root cannula to the sucker, or leave root site open. Blows on the lungs. Flow down. Release the clamp.

Close the RA starting with a over and over at the inferior corner, and take one needle off.

Come off CPB, check with epicardial echo. If any doubts, measure QpQs (RA and PA)

Pacing wires (RA, RV). Pericardial reapproximation. 1 drain. Routine chest closure.