Fontan operation with a viable and growing conduit using pedicled autologous pericardial roll: Serial changes in conduit geometry

A, A sufficiently large rectangular flap of pericardium was cut, leaving it pedicled so as to preserve its vascular connections, and the flap was then rolled into a tube shape. B, The schema of extracardiac grafting with a pedicled autologous pericardial roll (PAPR) conduit with the aid of a temporary bypass from the inferior vena cava (IVC) to the atrium. The left pulmonary artery was clamped to control retrograde blood return (not depicted for simplicity). The venoatrial junction was divided obliquely to obtain an adequate orifice for anastomosis between a PAPR conduit and the IVC, leaving a small sleeve of atrial musculature around the IVC.

Serial changes in pedicled autologous pericardial roll (PAPR) volume (A), artificial graft volume (B), PAPR volume indexed to body weight (C), PAPR diameter at the inferior vena caval (IVC) end (D), PAPR diameter at the IVC end indexed to normal right pulmonary artery (PA) diameter (E), PAPR diameter at the PA end (F), PAPR diameter at the PA end indexed to normal right PA diameter (G), widest/narrowest ratio in PAPR (frontal view; H), and widest/narrowest ratio in PAPR (lateral view; I).

Relation between cross-sectional area of pedicled autologous pericardial roll (PAPR) and body surface area (BSA). PA, Pulmonary artery.

Each graft was traced in both frontal (A) and lateral (B) views, the selected structure was divided into 32 cross-sections, and the cross-sectional areas of each slice were integrated to calculate graft volume (MULTI-SLICE method).

The ratio of the widest to the narrowest diameter in the pedicled autologous pericardial roll conduit was estimated in either the frontal (A) or lateral (B) view to determine proportional change in conduit shape.