PREVENTION OF UNBALANCED LUNG PERFUSION AND ATRIAL ARRHYTHMIAS AFTER THE LATERAL TUNNEL OPERATION

Background. The lateral tunnel operation has become increasingly popul ar with pediatric cardiac surgeons, as it is technically reproducible, is relatively easy to perform, and can be used in a variety of patien ts with single-ventricle physiology. The main drawbacks of the origina l operation are uneven blood flow distribution to the lungs and increa sing incidence of supraventricular arrhythmias over time. Methods. In 1988, we modified this technique by avoiding narrowing of the tunnel a t the superior vena cava-atrial junction, avoiding incorporation of th e crista terminalis in the baffle suture line, and minimizing damage t o the sinoatrial node. Between 1988 and 1995, 19 patients underwent th is operation at Marie-Lannelongue Hospital in Paris. Results. There wa s one early death and no late deaths. At a mean follow-up of 5.2 years , all survivors are in Ne ru York Heart Association class I. Early atr ial flutter, related to atrial scarring secondary to multiple previous surgical procedures, developed in 1 patient, and late atrial flutter developed in 1 patient who had a previous Blalock-Hanlon atrial septec tomy. All patients are currently in sinus rhythm. Atrial flutter did n ot occur in 17 patients who had had no previous atrial wall surgical p rocedure. Conclusions. We believe that the good long-term clinical res ults are directly attributable to our modifications, which ensure opti mal hemodynamics and absence of rhythm disturbances. All patients who had not previously undergone operation on the atrial wall were free fr om supraventricular tachyarrhythmias at a mean follow-up of 5.2 years. This is a consequence of protecting the sinus node, crista terminalis , and Bachmann's bundle. (C) 1997 by The Society of Thoracic Surgeons.