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Conversion to total cavopulmonary connection 9 years after closure of a large ventricular septal defect

Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan

^* Corresponding author. Division of Cardiovascular Surgery, Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. Tel.: +81-45-787-2645; fax: +81-45-786-0226
isomatsu{at}med.yokohama-cu.ac.jp

We performed an extracardiac total cavopulmonary connection (TCPC) operation using tissue-engineered graft for a patient with elevated central venous pressure due to severe tricuspid valve insufficiency 9 years after closure of a large ventricular septal defect. Before the TCPC, this patient had a right atrial thrombus and pulmonary embolism for which thrombolytic therapy was ineffective. The patient has been receiving anticoagulation therapy with both warfarin sodium and aspirin for 10 months after TCPC operation to avoid thrombotic complications. TCPC may be an alternative in selected patients with failing biventricular repair.

Key Words: Total cavopulmonary connection; Tissue-engineered graft; Pulmonary embolism; Tricuspid insufficiency