HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): William H. Fleming Alan R. Hopeman Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fleming, W. H. Articles by Mooring, P. K. Search for Related Content PubMed PubMed Citation Articles by Fleming, W. H. Articles by Mooring, P. K.

Ann Thorac Surg 1979;27:435-439
© 1979 The Society of Thoracic Surgeons

---

Articles

Late Complications Following Surgical Repair of Total Anomalous Pulmonary Venous Return below the Diaphragm

Departments of Pediatrics and Surgery, University of Nebraska Medical Center, Omaha, NE, and the Henrietta Egleston Hospital for Children, Atlanta, GA

^* Address reprint requests to Dr. Fleming, Department of Thoracic-Cardiac Surgery, University of Nebraska Medical Center, 42nd and Dewey Ave, Omaha, NE 68105

Between May, 1975, and June, 1977, we surgically repaired an infracardiac total anomalous pulmonary venous return in 4 infants under deep hypothermic cardiac arrest. All patients had pulmonary hypertension and a patent ductus arteriosus. All survived operation and required positive end-expiratory pressure with mechanical ventilation. Late complications included patent ductus arteriosus not visualized at initial catheterization, breakdown of an oversewn atrial septal defect repair, and pulmonary venous obstruction despite an anastomosis diameter of 1.5 to 2.5 cm. At reoperation, there was scarring and contraction at the junction of the pulmonary veins and left atrium. One infant with these complications died post-operatively. In another patient, there was kinking of the left lower pulmonary vein at its juncture with the left atrium.

In view of these complications we currently recommend the following: ligation of the ductus arteriosus regardless of catheterization findings; a right-sided approach to avoid pulmonary vein kinking; prosthetic patch closure of the atrial septal defect to avoid excessive tension on suture lines and to maintain maximum left atrial size; stellate anastomosis to provide the largest possible drainage channel, awareness that an unusually high positive end-expiratory pressure may be required postoperatively; and early recatheterization.

This article has been cited by other articles:

				C. Mavroudis and R. M. Sade The Southern Thoracic Surgical Association 50th anniversary celebration: the impact of STSA pediatric cardiothoracic surgery manuscripts on surgical practice Ann. Thorac. Surg., November 1, 2003; 76(90050): S47 - 67. [Abstract] [Full Text] [PDF]

				J. A. Hawkins, E. B. Clark, and D. B. Doty Total Anomalous Pulmonary Venous Connection Ann. Thorac. Surg., November 1, 1983; 36(5): 548 - 560. [Abstract] [PDF]