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KMID : 0367219920090010099
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Sejong Medical Journal
1992 Volume.9 No. 1 p.99 ~ p.104
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Total Cavopulmonary Connection
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나찬영
유재현/유환국/이원용/정윤섭/김응수/백완기/한재진/이영탁
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Abstract
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Total cavopulmonary connection was proposed as a modification of the Fontan procedure in cyanotic complex cardiac anomaly.
The operation was performed in 13 patients between April 1989 and May 1992. The diagnoses wre univentricular heart (8 patients), tricuspid atresia (3 patients), double outlet right ventricle combined with pulmonic stenosis and hypoplastic left
ventricle
(1 patient), and L-transposition of great artery with straddling atrioventricular valve (1 patient).
Previous palliative procedures were performed in 4 patients, including 2 systemic pulmonary shunts and 2 pulmonary artery bandings.
The patients were 6 males and 7 females, aged 9 months to 13 years (mean 3 yars 8 months), and weighted 8.1㎏ to 38㎏(mean 14.8㎏).
Preoperative hemodynamic states revealed a mean pulmonary artery pressure 13.8mmHg (tranged 7 to 29mmHg), a mean pulmonary venous pressure 9mmHg (ranged 4 to 13mmHg), a mean pulmonary artery index 317 u/㎡(ranged 195 to 633 u/㎡) , and a mean
pulmonary
vascular resistance 1.96 u/㎡(ranged 1 to 3.4 u/㎡).
Total cavopulmonary connection (exclusion of most or all of the right atrium) consists of 1) end to side anastomosis of the superior vena cava to the undivided right pulmonary artery, 2) constructionof a composite intraatrial tunnel with the use
of
the
posterior wall of the right atrium, 3) use of a prosthetic patch to channel the inferior vena cava to the transected superior vena cava.
There are 3 early death and one late death due to low cardiac output syndrome. Perioperative changes of mean hematorit and mean arterial oxygen saturation were from 58% to 33.7% and form 80% to 94.3% respectively. Survivals showed good result
without
cyanosis during the 2 to 37 month(mean 12 month)follow up period.
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KEYWORD
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