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Ann Thorac Surg 1996;62:1888
© 1996 The Society of Thoracic Surgeons

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Correspondence

Improved Exposure for TAPVC Repair by Posterior Approach

Department of Cardiothoracic Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India

To the Editor:

The technique of elevating the cardiac apex provides excellent exposure in the supracardiac and infracardiac total anomalous pulmonary venous connection [1]. The left-sided or more direct approach allows the use of a more generous portion of the left atrial wall from septum to appendage. This exposure also permits the atrial appendage to be used as a venous arterioplasty for the enlargement of the pulmonary venous orifice [2] and hence a wide anastomosis can be assured between the left atrium and the pulmonary venous chamber. However, the major limitation is that of holding the heart in the correct alignment and also preventing any myocardial and epicardial coronary injury by the sustained pressure of the retractors and other instruments. We have developed a simple technique of achieving excellent exposure and overcoming the above-mentioned difficulties. We use angled cannulas for the superior and inferior venae cavae and put a stay suture at the apex of the left atrial appendage. Next the right pleura is widely opened, and no pericardial stay sutures are put on the right side. Subsequently the heart is rotated completely and dropped into the right pleural cavity with the two caval cannulas acting as a hinge. The atrial appendage stay suture is pulled up, which gives excellent exposure of the entire left atrium, the left atrial appendage, and the pulmonary venous chamber. Thereafter the anastomosis can be done without any additional retraction.

References

1. Williams GR, Richardson WR, Campbell GS. Repair of total anomalous pulmonary venous drainage in infancy. J Thorac Cardiovasc Surg 1964;47:199–204.
2. Yee ES, Turley K, Hsreh W, Ebert PA. Infant total anomalous pulmonary venous correction. Factors influencing timing of presentation and operative outcome. Circulation 1987;76(Suppl 3):83–7.

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This Article Alert me when this article is cited Alert me if a correction is posted 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): Anil Bhan Krishna S. Iyer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bhan, A. Articles by Venugopal, P. Search for Related Content PubMed PubMed Citation Articles by Bhan, A. Articles by Venugopal, P.