Bicaval pulmonary connection in tricuspid atresia using an extracardiac tube of autologous pediculated pericardium to bridge inferior vena cava

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Abstract
From August 1989 to April 1991, four children, 1.5 to 4 years old withtype IIb tricuspid atresia underwent total right heart bypass by means of abicaval pulmonary connection using an extracardiac conduit of pediculatedpericardium between the inferior vena cava and the main pulmonary artery.The tube was made from a large rectangular flap of the patient's ownpericardium, pediculated along the right border, ensuring a vascularsupply. The diameter of the tube, calibrated on a Hegar probe, equals thatof the inferior vena cava, and the length is adapted to bridge the gapbetween the inferior vena cava and the main pulmonary artery. All fourpatients had an uneventful postoperative course. Assisted ventilation wasstopped on the next morning and the chest tubes removed on the 2nd or 3rdday. The liver was only moderately enlarged and no pleural effusionsdeveloped. Sinus rhythm was permanent. Echocardiographic monitoring 6-10months after the hospital discharge showed patent tubes, no collapse duringthe cardiac cycle, and no wall thickening and a laminar flow. Theadvantages of the pediculated pericardial tube are that no prostheticmaterial is used. There is no thrombogenicity or antigenicity. These tubesretain a growth potential, and we believe that this material is suitablefor use in young patients.

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