title: Appropriate route selection for extracardiac total cavopulmonary connection in apicocaval juxtaposition.
abstract: BACKGROUND
  A malpositioned heart with apicocaval juxtaposition may complicate the management of patients with functional single ventricles when total cavopulmonary connection is performed. We reviewed our experience with extracardiac total cavopulmonary connection in patients with apicocaval juxtaposition with a special focus on route selection and outcomes.
  
  
  METHODS
  Of 68 patients who underwent extracardiac total cavopulmonary connection at our hospitals, 10 patients with apicocaval juxtaposition were included in this study. The mean follow-up was 40 ± 28 months. Patient demographics were compared with data on patients without apicocaval juxtaposition.
  
  
  RESULTS
  The age at operation was 8 ± 7 years. We carefully chose conduit routes to create satisfactory fluid dynamics. The conduit was placed between the inferior vena cava and the ipsilateral pulmonary artery in 2 patients, and the conduit crossed midline in 8 patients. The mean postoperative pulmonary artery pressure was 13 ± 2 mm Hg. The surgical and postoperative data were not significantly different when compared with the patients without apicocaval juxtaposition. There were no conduit-related early or late complications except for 1 patient who had poor ventricular function.
  
  
  CONCLUSIONS
  Extracardiac total cavopulmonary connection in apicocaval juxtaposition can be carried out with favorable midterm outcomes. The route between the inferior vena cava and the contralateral pulmonary artery should be the primary choice when the relevant pulmonary artery is in good shape. Care must be taken in regard to critical conduit oppression by the ventricle in cases with large ventricular volume or poor ventricular function.
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Sei
authors.initials: S
authors.lastname: Morizumi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kato
authors.forename: Shinya
authors.initials: S
authors.lastname: Kanemoto
authors.forename: Mio
authors.initials: M
authors.lastname: Noma
authors.forename: Masakazu
authors.initials: M
authors.lastname: Abe
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Sakakibara
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hiramatsu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018610:Heart Bypass, Right / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D011651:Pulmonary Artery / Q000601:surgery; D012189:Retrospective Studies; D014682:Vena Cava, Inferior / Q000601:surgery