CLINICAL, HEMODYNAMIC AND ANGIOGRAPHIC RE SULTS AFTER TOTAL CAVOPULMONARY CONNECTION

The aim of the study was to assess the short and medium term results o f total cavo-pulmonary connection based on analysis of the functional status, the cavo-pulmonary circulation and the surgical techniques, an d the hepatic consequences. Fifteen patients with congenital defects b eyond repair were treated by total cavopulmonary connection at Tours b etween March Ist 1992 and July 30th 1996. There were 12 children (mean age: 6.3 years) and 3 adults aged 25 to 28. Results were assessed by clinical examination, hepatic function tests and cardiovascular invest igations including right heart catheterisation with angiography in 14 patients. There were no fatalities. Seven patients were in functional Class I and 8 in Class II at medium term (average follow-up of 33 mont hs). Hepatic function was mildly abnormal in all patients with an incr ease in serum bilirubin and gamma GT, and a decrease in the coagulatio n factors. The mean pressures in the atrial channel were 12 mmHg (9-16 mmHg), in the superior vena 13.2 mmHg (10-18 mmHg), in the right pulm onary artery 9.5 mmHg (7-15 mmHg) and 11.6 mmHg (8-16 mmHg) in the lef t pulmonary artery. Significant residual stenosis of a pulmonary branc h was observed in 2 cases. The cavo-pulmonary anastomoses were out of line, one from the other, in all cases. The atrial channel was tubular in 9 cases and dilated with slight stagnation of the contrast medium in its inferior region in 5 cases. Total cavopulmonary connection tran sformed the clinical status of these patients but was associated with minor abnormalities of liver function. The quality of the cavo-pulmona ry circulation and the surgical anastomoses was estimated to be satisf actory in the majority of cases.