Physiological approach to surgery for tricuspid atresia.

A modification of Fontan's approach to the surgical management of tricuspid atresia was employed in nine patients. A valved conduit was used to create continuity between the right atrium and the surgically modified right ventricular chamber. Six patients had had previous shunting procedures. Preoperative studies revealed various degrees of hypoplasia of the right ventricle beneath relatively normal pulmonary valves. At surgery, the atrial septal and ventricular septal defects were closed, the right ventricular chamber was enlarged, and right atrial-right ventricular continuity was established with a valved conduit. There was one operative death. The eight survivors have been clinically well as long as 3 1/2 years following surgery. Postoperative cardiac catheterization was performed in five patients. Ventricularized pressure tracings were recorded in the right ventricular chambers and the morphology of the atrial and pulmonary artery pressure curves were normal. In all instances, angiography demonstrated significant enlargement of a pulsatile right ventricular chamber. Thus, in many patients with tricuspid atresia, establishment of a four-chambered, four-valved heart is feasible, both from an anatomic and physiologic standpoint.