Figure 29: Two hearts after repair of TOF with the right ventricle opened. A - This heart was operated in an earlier era when wide patch plasty of the right ventricular outflow was the standard. Note the large patch defined by the arrowheads over the outflow (blue curved arrow). The ventricular septal defect patch (VSD) is seen between the tricuspid valve (TV) and the outflow. B - The outflow patch (arrowheads) is much smaller in a heart operated more recently. The patch crosses the pulmonary annulus (white dotted line) and extends onto the left pulmonary artery (LPA).