Modification Of The Extracardiac Total Cavopulmonary Connection - Placement Of A Graft Antero-Medially Rather Than Laterally

In the conventional extracardiac total cavopulmonary connection (TCPC), a graft is placed lateral to the atrium. To prevent pulmonary venous obstruction, a thorough dissection around the pulmonary veins is required. The cause of sinus node dysfunction after extracardiac TCPC is still unknown. One possibility may be a compression of the sinus node from the outside by the graft. In this report, we proposed to modify TCPC by implanting a graft antero-medially rather than laterally to prevent the aforementioned complications. Six patients underwent this modified technique of TCPC. There was no death. The average pulmonary arterial pressure was 11 mmHg. The average follow-up was 24 months. No pulmonary venous stenosis or sinus node dysfunction was observed. In the conventional TCPC, the flow from the superior vena cava directly collides with the flow from the inferior vena cava at the central pulmonary artery (PA) resulting in energy loss. The central PA slightly curves anteriorly to posteriorly. In this modified technique, the flow from the graft enters the central PA from the front and may smoothly advance backwards into the distal PA along its naturally curved line. Thus, this modified technique may produce less energy loss compared to the conventional extracardiac TCPC.