Total cavopulmonary connection with straight conduit for apicocaval juxtaposition.

If the heart is malpositioned with apicocaval juxtaposition (ACJ), what constitutes the ideal course for the conduit pathway of a total cavopulmonary connection must be considered. When the conduit is positioned between the inferior vena cava and the same side of the pulmonary artery behind the ventricle, potential stenosis of the conduit due to compression by the ventricle or obstruction of the pulmonary vein due to compression by the conduit must be recognized. We reported two cases of ACJ in which a straight conduit pathway behind the ventricle was accomplished. Comprehensive dissection of the heart, especially the posterior side of the ventricle, to make a wide opening into the thoracic cavity is needed to obtain enough space behind the ventricle. Postoperative catheter studies performed 6 months after the operations showed no obstruction or deformity of the conduit or the pulmonary veins, and the mean pulmonary artery pressure measured 9 mmHg in both patients.