TOTAL CAVOPULMONARY CONNECTION (TCPC) FOR COMPLICATED CONGENITAL HEART MALFORMATIONS

We reviewed our experience with 40 patients who had undergone total ca vopulmonary connection (TCPC) during the past three years. Thirty-one patients had functional single ventricle; only 8 of these with tricusp id atresia, five patients had complex forms of double outlet right ven tricle (DORV), and four complex A-V canal. Previous palliative procedu res, mostly systemic-pulmonic shunts, were performed in 34 patients. C oncomitant procedures were required in 18 patients, mainly reconstruct ion of distorted pulmonary arteries. A subgroup of 14 high risk patien ts, that did not fulfil the classical Fontan criteria, underwent 4 mm fenestration of the intra-atrial baffle. There were three (7.5%) early postoperative deaths which occurred in the higher risk group (fenestr ated group). However, the remaining patients were all in functional cl ass I or II. Total cavopulmonary connection provides reasonably good d efinitive palliation for patients with single ventricle physiology. Fe nestration of the intra-atrial baffle increases the number of candidat es suitable for the Fontan procedure, although the exact inclusion cri teria for these patients has yet to be defined.