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

From August 1989 to April 1991, four children, 1.5 to 4 years old with type IIb tricuspid atresia underwent total right heart bypass by means of a bicaval pulmonary connection using an extracardiac conduit of pediculated pericardium between the inferior vena cava and the main pulmonary artery. The tube was made from a large rectangular flap of the patient's own pericardium, pediculated along the right border, ensuring a vascular supply. The diameter of the tube, calibrated on a Hegar probe, equals that of the inferior vena cava, and the length is adapted to bridge the gap between the inferior vena cava and the main pulmonary artery. All four patients had an uneventful postoperative course. Assisted ventilation was stopped on the next morning and the chest tubes removed on the 2nd or 3rd day. The liver was only moderately enlarged and no pleural effusions developed. Sinus rhythm was permanent. Echocardiographic monitoring 6-10 months after the hospital discharge showed patent tubes, no collapse during the cardiac cycle, and no wall thickening and a laminar flow. The advantages of the pediculated pericardial tube are that no prosthetic material is used. There is no thrombogenicity or antigenicity. These tubes retain a growth potential, and we believe that this material is suitable for use in young patients.