Total cavopulmonary anastomosis using atrial septal flap: technique and early results

Abstract

Introduction. The Fontan procedure has undergone many modifications to avoid atrial arrhythmias and thrombus formation. We used patient's interatrial septum as a flap to direct the inferior venacaval blood to the superior venacava.Methods. Seventeen patients, aged I to 17 years, underwent modified total cavopulmonary anastomosis. lnteratrial septum was used to create the inner half of the atrial tunnel, outer half being formed by right atrial free wall. Post-operatively, all patients underwent echocardiography. Seven patients underwent 24 hour ambulatory Holter monitoring and 6 patients underwent cardiac catheterization and cineangiography.Results. There was one early death due to low cardiac output. One patient had transient supraventricular arrhythmia.Two patients had singnificant pleural effusion. Holter Monitoring reveled sinus rhythm in all 7 patients studied. Follow up ranged from 18 to 60 months and patients were evaluated as they came for follow up. Long term follow up is currently being compiled. There was one late death from a non-cardiac cause. The remaining patients were in New York Heart Association (NYHA) Class I or II. All patients were in sinus rhythm. Echocardiography and cineangiography revealed absence of obstruction or leak.Conclusions. Total cavopulmonary anastomosis using autogenous atrial septum is a useful modification for classical cavopulmonary anastomosis and provides good early results. (Ind J Thorac Cardiovasc, Surg 2000; 16: 15-18)

Eustachian Valve as a Cardiovascular Patch

“…It is easy to handle and readily available but has no growth potential and acts as foreign material in contact with systemic circulation, therefore anticoagulation is required. When the Fontan operation is accomplished using autologous atrial septal tissue to create a lateral tunnel, growth potential persists and anticoagulants are not required [10]. Either bovine or autologous pericardium has been used in the extracardiac Fontan operation to avoid an atriotomy and avoid disruption of intra-atrial conduction and can be easily fenestrated.…”

Reducing the costs of surgical correction of congenitally malformed hearts in developing countries

“…In older children and adults with congenital heart disease, an interlocking lazy “S” shaped sternotomy instead of the conventional straight sternotomy might improve the post-operative respiratory recovery and reduce the hospital stay and costs of respiratory physiotherapy 23 . Other examples include the performance of bidirectional superior cavopulmonary anastomosis without cardiopulmonary bypass, 24 , 25 preferring repair rather than repair of heart valves whenever feasible, 26 using autologous tissues rather than prosthetic tubes or patches, 16 , 27 and developing techniques such as bypass of the right heart for procedures in selected patients 28 . The latter technique was found to reduce the costs of the bidirectional superior cavopulmonary anastomosis by as much as two-fifths 28 .…”