Completion extracardiac, non-fenestrated, total cavo-pulmonary connection using a polytetrafluoroethylene conduit: a video presentation

Abstract

Direct connection of both cavae to the pulmonary artery would be the ideal right heart bypass by virtue of elimination of prosthetic material and extensive atrial suture lines. When the direct connection is impossible, this may be accomplished by a prosthetic graft or a viable in situ pedicled pericardium. The extracardiac technique separates the high-pressure conduit from the atrial wall and systemic venous atrial cavity, avoids intra-atrial placement of prosthetic material, theoretically minimizes the risk of supraventricular arrhythmias and possibly preserves ventricular and pulmonary function because it can be performed without aortic cross-clamp. Concerns include lack of growth potential of the synthetic conduit, late supraventricular dysrhythmias, conduit narrowing or obstruction and thromboembolic complications [1-5]. A 14-year-old female patient diagnosed with a functionally univentricular heart, hypoplastic left ventricle, anteroposteriorly related great arteries who had prior superior cavopulmonary anastomosis without antegrade flow interruption at the age of nine years, underwent extracardiac, non-fenestrated, total cavopulmonary connection using a 20 mm polytetrafluoroethylene conduit. The post-operative Fontan pathway pressure was 16 mmHg with stable hemodynamics. Post-operative recovery was uneventful.