[Extracardiac pulmonary bypass in the treatment of tricuspid atresia].
Six patients aged 1.5 to 4 years with type 13 tricuspid atresia underwent extracardiac bicavopulmonary repair. This corrective procedure comprises control of palliative aorto-pulmonary anastomosis, the construction of an anastomosis between the superior vena cava and right pulmonary artery and the interposition of an extracardiac tube of autologous pediculated pericardium between the inferior vena cava and the main pulmonary artery. This tube, fashioned from a rectangular flap, remains attached along its right border, conserving its vascular pedicle with the pericardium. Its diameter is calibrated to that of the inferior vena cava. The postoperative course was uncomplicated: all children survived. Assisted respiration was discontinued 24 to 36 hours after surgery, and the pleural drains withdrawn after 48 to 72 hours. The rhythm remained sinusal. Central venous pressure ranged from 8 to 12 mmHg. Peripheral arterial situation was over 95%. At follow-up at 3 to 15 months, the children were very active, reflecting good exercise capacity. Holter monitoring was normal. Saturation was 94 to 97%. Doppler echocardiography showed laminar blood flow. This technique insures good venous drainage without any prosthetic thrombogenic material. In addition, the pediculated pericardium conserves a potential for growth, justifying its use in small children. Long-term evaluation is essential but the initial results are encouraging and encourage perseverance with this method.
Hvass
U
U
Hôpital Bichat, chirurgie cardiovasculaire, Paris.
Debauchez
M
M
Abou-Eid
G
G
Pansard
Y
Y
Bohm
G
G
Depoix
J P
JP
Cloez
J L
JL
Worms
A M
AM
D000714:Anastomosis, Surgical / Q000379:methods; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010496:Pericardium / Q000601:surgery; D011651:Pulmonary Artery / Q000601:surgery*; D014261:Tricuspid Valve / Q000002:abnormalities* / Q000601:surgery; D014683:Vena Cava, Superior / Q000601:surgery*
Dérivation bicavo-pulmonaire extracardiaque dans le traitement de l'atrésie tricuspide.