Methods: Review all hand sewn right ventricular outlet valves created by the author in the setting of repaired Tetralogy of Fallot where the native pulmonary valve could not be preserved. The valves were assessed by serial trans thoracic echocardiography and more recently by magnetic resonance imaging angiography for late valve function. The bileaflet Goretex valves were constructed in a standardised fashion from a semicircle of 0.1mm Goretex,(whose radius equalled the length of the outflow tract incision) that gave a lengthened free edge to the leaflets, central fixation of the free edge posteriorly just proximal to the branch pulmonary arteries and generous augmentation of the outflow tract with Goretex patchplasty. The bileaflet configuration shortens the closing time against the posterior wall and the leaflets are forced to maintain their configuration without prolapse into the right ventricular outlet.The valve can be generously oversized in young children to avoid the need for replacement. (operative video)

Results: 53 patients met the selection criteria. 22 patients had fresh autologous pericardial monocusps constructed, 9 patients had Goretex (0.1mm) monocusps constructed and 22 patients have had bileaflet Goretex (0.1mm) outlet valves constructed.The pericardial valves have the longest follow up and all developed free pulmonary incompetence. Goretex monocusps had reliable competence early after surgery but progressed to pulmonary incompetence. The bileaflet Goretex (0.1mm) valves have remained competent with regurgitant fractions of 5% to 30% only (MRI angiography)and this has remained stable with time.Maximum follow up for this valve is 5 years.No instances of stenosis or peripheral emboli have been recognised and none have been replaced to date.

Conclusion: Hand sewn bileaflet Goretex valves in the right ventricular outlet can reliably provide competence and maintain function in the medium term. Their shape and size allows placement in young children with a reasonable expectation that they remain competent with growth of the native annulus and not need replacement. Their durability is superior to the pericardial and Goretex monocusp valves in this series.