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Clinical analysis of intracardiac diploe lateral-tunnel total cavopulmonary connection in the treatment of complex congenital heart diseases

Huang Zhongyao, Chen Daozhong, Qiu Zhihuang

Objective: To analyse the clinical efficacy and safety of intracardiac diploe lateral-tunnel total cavopulmonary connection in the treatment of complex congenital heart diseases.

Methods: A total of 32 children with complicated congenital heart disease in our hospital from January 2010 to January 2016 were enrolled, including 11 cases with tricuspid valve atresia, 15 cases with single functional ventricles, and 6 cases with correct transposition of great artery. Surgery was performed under moderate hypothermic cardiopulmonary bypass. The patients took supine position for thoracotomy, followed by the isolation of pulmonary artery and left and right arteries. The superior vena cava was cut off for the end-to-side anastomosis of right pulmonary artery, blocking the aortic from filling protective liquid. With the incision of right atrium and the resection of atrial septum, the defect of atrial septum was widened to 2~3 cm. The pericardium slice was used as intracardiac lateral tunnel with fenestration of 0.4~0.5 cm. The pulmonary aorta of proximal arterial was cut off, and anastomosis of distal arterial and superior vena cava was performed while proximal arterial received suture.

Results: The mean arterial pressure, oxygen saturation and urine output were significantly different after operation (P<0.05), while there was no significant difference in central venous pressure (P=0.183>0.05). Postoperative early death occurred in 2 cases (6.3%) due to low cardiac output and cardiac arrest. Postoperative complications occurred in 7 cases (21.8%), pulmonary edema in 2 cases (6.3%), pleural effusion in 3 cases (9.4%), pericardial effusion in 1 case (3.1%), and arrhythmia in 1 case (3.1%). The thirty patients were followed up for 6 to 36 months. Two patients (6.7%) had chest resuscitation and improved after treatment.

Conclusion: The intracardiac diploe lateral-tunnel total cavopulmonary connection achieved good results in the treatment of complex congenital heart diseases.