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