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The Use of the Right Atrial Flap in Total Cavopulmonary Connection
Author(s) -
STARK JAROSLAV,
KOSTELKA MARTIN
Publication year - 1991
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.1991.tb00331.x
Subject(s) - medicine , inferior vena cava , tricuspid atresia , cardiology , superior vena cava , pulmonary artery , tricuspid valve , fontan procedure , stenosis , anastomosis , central venous pressure , atresia , surgery , heart disease , blood pressure , heart rate
A bstract A technical modification of total cavopulmonary anastomosis (TCPC) is described. Inferior vena cava (IVC) channel is constructed from the right atrial wall in a fashion similar to Senning's operation. The use of Gore‐Tex R (W.L. Gore & Associates, Inc.) patch or tube is avoided. We have used the technique in 11 patients between 1988 and 1991 (six complex transpositions or double outlets with one hypoplastic ventricular chamber and/or straddling of the atrioventricular (AV) valve, four double inlet ventricles with pulmonary stenosis, and one tricuspid atresia). Superior vena cava (SVC)/IVC to pulmonary artery gradient was < 2 mmHg in all patients. SVC/IVC pressure was 10–15 mmHg (mean 12.3 mmHg), transpulmonary gradient 5–8 mmHg (mean 6.4 mmHg). We have not observed any adverse effects such as arrhythmias or increased pleural drainage when we compared those patients with 85 children in whom the TCPC was performed with Gore‐Tex R patch/tube. The presented technique is simple, avoids the use of anticoagulants, and may have a possible long‐term advantage in allowing growth of the IVC channel.