TOTAL CAVOPULMONARY CONNECTION FOR COMPLICATED CONGENITAL HEART MALFORMATIONS

We reviewed our experience with 40 patients who had undergone total ca vopulmonary connection during the past 3 years. Thirty-one patients ha d functional single ventricle, only 8 with tricuspid atresia; five had complex forms of double outlet right ventricle, and 4 complex A-V can al. Previous palliative procedures, mostly systemic-pulmonic shunts, w ere performed in 34 patients. Concomitant procedures, mainly reconstru ction of distorted pulmonary arteries, were required in 18 patients. A subgroup of 14 high risk patients, who did not fulfil the classical F ontan criteria, underwent 4 mm fenestration of the intraatrial baffle. There were 3 (7.5%) early post-operative deaths that occurred in the higher risk group (fenestrated group). However, the remaining patients were all in functional class I or II. Total cavopulmonary connection provides reasonably good definitive palliation for patients with singl e ventricle physiology. Fenestration of the intraatrial baffle increas es the number of candidates suitable for the Fontan procedure, althoug h the exact inclusion criteria for these patients has yet to be define d.