Successful Conversion of Atriopulmonary Anastomosis to Total Cavopulmonary Connection Using Autologous Atrial Flap / 日本心臓血管外科学会雑誌

ABSTRACT

We report a successful conversion of atriopulmonary anastomosis to total cavopulmonary connection using an autologous atrial flap. A 28-year-old man after atriopulmonary anastomosis with a valve conduit performed under a diagnosis of double inlet left ventricle (DILV), d-TGA, was admitted with moderate cyanosis and atrial fibliration which he had suffered since age 25. Cardiac catheterization and ultrasonic cardiography revealed regurgitation at the site of tricuspid patch closure, and atrial dilatation. We excised the regurgitated patch, closed tricuspid valve leaflets, and made an atrial lateral tunnel using an autologous atrial flap. In particular we took care of crista terminalis, sinus node arteries, and sinus node at the operation. He recovered his sinus rhythm on the first operative day, but secondary atrial fibrillation developed. Four months later, catheterization showed good hemodynamics with low central venous pressure, and no obstruction of the atrial tunnel.