Assesment of mew oprative method using sutologous right atriun in order to improve the QOL in comlex heart defects.

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The adventages of total cavopulmonary connection (TCPC) have been acknowledged at this present. With regard to atrial pulsatile force, however, the original Fontan procedure is superior to TCPC.So, we have extended the application of using autologous right atrial flap to TCPC,and pulmonary flow was assessed by intrapulmonary doppler echo cardiography (Flow wire) and measured ANP,BNP so called cardiac hormone in ten patients who underwent TCPC procedure.Pulmonary flow pattern was obtained by pulse doppler, using 15Mhz transducer of 0.014inch guide wire type (Flow wire).Group I(N=6) showed pulsatile flow signal and group II(N=4) was not pulsatile. Three of six in group I were tricuspid atresia and the other three were univentricular heart. Three of four in group II were univentricular heart and one was pure pulmonary atresia. Age was 8.8(]SY.+-。[)5.7 years in group I and 16.0(]SY.+-。[)9.1 years in group II.On the procedure of rerouting from inferior venae cavae to the pulmonary artery, the autologous right atrial wall was used in all cases of group I and two cases of group II.Right atrial volume index (ml/m<@D12@>D1) was 30(]SY.+-。[)5 in group I and 20(]SY.+-。[)8 in group II.The ejection fraction (%) of right atrium was 33(]SY.+-。[)11 in group I and 9(]SY.+-。[)2 in group II.ANP and BNP were recognized no tendency among two groups.Conclusion : 1) Using autologous right atrial wall in TCPC could provide pulsatile flow in pulmonary circulation. 2) Accelerating factors of this effect are tricuspid atresia and yonger age. 3) ANP and BNP so called cardiac hormone were recognized no tendency in this assesment.