What is Total Cavo Pulmonary Connections (TCPC)-Lateral Tunnel Operation?

Cardiopulinonary bypass is instituted by cannulation of ascending aorta, SVC innominate vein junction and IVC at diaphragmatic level. Patient is cooled down and on total cardiopulmonary bypass aorta clamped and heart arrested by infusion of cold cardioplegia. The right atrium is opened. The pulmonary trunk is transacted and proximal end over'sewn. The distal end of pulmonary trunk is also doubly sutured. The superior vena cava is transected as it crosses right pulmonary artery. Azygos vein is ligated and divided. The upper divided end of SVC is anastornosed to the superior aspect of right pulmonary artery as in bidirectional Glenn operation. The lower end of divided SVC is then anastomosed to under aspect of light pulmonary artery. The anastomosis is made as wide as possible. Attention is then concentrated to make a lateral tunnel inside right atrium to divert the entire inferior' vena caval blood through the superior vena caval inlet on to the right pulmonary artery. A PTFE (Goretex) graft is cut open and appropriately shaped to form part of the lateral tunnel. Right atrial wall completes the other wall of the tunnel. Atrial septal defect is enlarged in univentricular heart where the right AV valve is the main inlet. The coronary sinus drains into the lower pressured left atrium.

A fenestrated Fontan is preferred where a higher venous pressure is anticipated. A circular hole of 4, 5 or 6 nun is made on the PTFE patch using an aortic punch. Same object can be achieved by a purse string applied at the junction of the Goretex patch with lateral wall of atrium. If the sutures are brought out through the skin on a snare the opening can be controlled externally. The patient is monitored and when it is not required it can be closed with a device after trial closure with balloon.