Double-outlet extension for narrowed retroaortic space

In cyanotic congenital heart disease, an enlarged aorta often compresses the retroaortic space, resulting in pulmonary artery narrowing. We experienced a case of a 10-year-old boy with severe pulmonary artery stenosis resulting from a narrowed retroaortic space after a Rastelli operation. The right pulmonary artery was closely aligned with the left coronary artery, which made pulmonary artery stenting difficult. We performed surgical repair including aortic extension with an interposition graft and elongation of the right ventricular outflow tract (double-outlet extension). This procedure was effective for enlargement of the retroaortic space and separation of the pulmonary artery from the coronary artery.