Successful surgical correction in two patients with tricuspid atresia using autologous pericardial valve-bearing tube graft

Abstract

A modification of the Fontan procedure has been used successfully to correct tricuspid atresia in two children who had severe hypoplasia of the pulmonary artery. In the first patient (who had functioning Gleen anastomosis) the hypoplastic left pulmonary artery was widened by an angioplasty, and then a Dacron external conduit containing an autologous pericardial valve (an autologous pericardial valve-bearing tube graft) was positioned to lead from the right atrial appendage to the left pulmonary artery. A large secondum type atrial septal defect was closed by a Dacron patch. In the 2nd patient, a Dacron external conduit withhout any valve was placed between the right appendage and the hypoplastic right ventricle and then the pulmonary outflow tract was widened by using an autologous pericardial valve patch, which was an extension of the external conduit. The ventricular and atrial septal defects were closed with patches. Both patients made a satisfactory recovery and were doing well 4 months after the operation. This type of modification of the Fontan procedure may provide a more effective functional correction for patients with tricuspid atresia who are accompanied with severe pulmonary hypoplasia.