Cardiac transplantation
Using appropriate reconstructive techniques, orthotopic cardiac
transplantation has been performed in selected individuals with right
isomerism, a functionally single ventricle, and totally anomalous
pulmonary venous connection. The techniques include interposed spiral
saphenous vein grafts, superior and inferior intraatrial baffles, a
composite cavopericardial graft to the right brachiocephalic vein, a
diaphragmatic pericardial tunnel, and separate right and left pulmonary
venous cuffs. Dacron conduits placed between the right-sided atrium and
the left superior caval vein, along with counter-clockwise rotation of
an anastomosis to the left sided inferior caval vein, have permitted
restoration of continuity of the systemic venous
return.24,25,51-53