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The Annals of Thoracic Surgery, Vol 49, 734-738, Copyright © 1990 by The Society of Thoracic Surgeons
SJ Phillips, C Kongtahworn, RH Zeff, JR Skinner, B Chandramouli and JH Gay
Six infants with total anomalous pulmonary venous connection below the
diaphragm had correction by modification of conventional surgical
technique. Catheterization revealed the confluence of the pulmonary veins
draining into a descending vein below the diaphragm. Symptoms of pulmonary
venous hypertension and low cardiac output were typical. All had repair
with circulatory arrest (average time, 32 minutes). Mobilization of the
pulmonary veins and the descending vein is important. The descending vein
was transected at the diaphragm. Its anterior surface was incised through
the confluence of the pulmonary veins, thus creating an open Y incision.
This large Y-shaped vein was anastomosed to the left atrium and carried
obliquely to the tip of the left atrial appendage. The anastomosis was
fashioned so that the long limb of the Y rotated anteriorly and superiorly
to substantially enlarge the left atrium, making the total diameter of the
anastomosis larger than the mitral valve orifice. This simplified the
surgical repair and allowed direct suture closure of the atrial septal
defect in all patients, as the left atrial size was at least doubled. No
postoperative complications occurred, and the patients were discharged an
average of 4.2 days postoperatively. Restudy at an average of 3.5 years
revealed normal pressures and normal architecture by angiography. Use of
the descending vein as an integral part of the reconstruction and
enlargement of the left atrium was the major technical factor leading to a
successful outcome in these patients and eliminating a patch or
transposition of the atrial septum.
ARTICLES
Correction of total anomalous pulmonary venous connection below the diaphragm
Department of Cardiovascular Medicine, Mercy Hospital Medical Center, Des Moines, Iowa.
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