Results Of Intra-Atrial Lateral Tunnel Fontan In Five Patients

Background:In 1971, Fontan procedure was first introduced to treat tricuspid atresia successfully. It is nowadays widely used where a patient only has a single effective ventricular, which is due to various complex congenital heart disease. While the surgery techniques and perioperative management never stop improving, some of the classic ten indications have been reconsidered and somewhat replaced by more severe conditions, the changing indications includes age, anomalous pulmonary vein connection, sinus rhythm, pulmonary artery/aorta ratio. Atriopulmonary connection, known as the original Fontan procedure is rarely used today due to the hemodynamic deficiency and excessive complications. Total cavopulmonary connection as an modified Fontan procedure was widely used because it proved to be hemodynamic efficient and showed less complications. In early times, atrial baffle was usually made of artificial material such as Gore Tex in total cavopulmonary connections. The disadvantage that artificial material can not grow as the body does, however, making it less favorable.Theoretically Autologous pericardium still stand a chance of growing after turning to atrial baffle. In addition, atrial fenestration shows a significant reduction in postoperative pleural effusion. Objective:To summarize the clinical experience in the management of complex congenital heart disease treated with intracardiac pericardial-flap LTF.Methods:Between September 2007 and December 2009, there were 5 patients treated with intracardiac pericardial-flap LTF in this hospital, the diagnosis included(tricuspid atresia, single ventricular and corrected transposition of great arteries). Their age was 7.6±5.5years(4～9.5years). All surgeries was under general anesthesia and cardiopulmonary bypass in moderate to mild hypothermia. Median sternotomy was made in a supine position, pulmonary artery, left and right pulmonary artery was fully exposed and released. Superior vena cava was cut off where it was lcm from right atrium, and an end to side anastomosis was performed with the distal SVC and right pulmonary artery. The pulmonary artery was cut off as close as possible to the pulmonary valve, and the proximal end was then closed by running suture. Cold myocardial cardioplegia perfusion was performed after clamping the aorta. A right atrium incision was made, atrial septal was removed through this incision, and the ASD was expanded to a diameter of 2 to 3cm. Intra atrial lateral tunnel was constructed with autologous Pericardial-flap as the atrial baffle, and the baffle was then Fenestrated by 0.4cm to 0.5cm in diameter. Anastomosis was performed with proximal inferior vena cava and main pulmonary artery, thus the connection between SVC and RPA, IVC and MPA was finally done.Results:1.There was no early mortality, no arrhythmia, no low cardiac output syndrome. pleural effusion was found in 3 patients.2.The followed up period was 5 to 30 months. There was no midterm mortality, no reintervention and thrombosis. The SaO2 and activity was improved significantly.Conclusion:1.The early and midterm outcome of the patients treated with intracardiac pericardial-flap LTF is satisfying.2.Autologous pericardium could be an ideal material for intracardiac pericardial-flap LTF.3. Atrial fenestration reduces pleural effusion and hospital stay.