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Ann Thorac Surg 2008;86:1028. doi:10.1016/j.athoracsur.2007.11.010
© 2008 The Society of Thoracic Surgeons
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Fabrice Vanhuyse
Jean Pierre Villemot
Loic Macé
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Images in Cardiothoracic Surgery

Total Anomalous Pulmonary Connection With an Unusual Drainage

Fabrice Vanhuyse, MDa,*, Francois Marçon, MDc, Laurence Menard, MDb, Jean Pierre Villemot, MDa, Loic Macé, MD, PhDa

a Department of Cardiac Surgery, Centre Hospitalier Universitaire Nancy, Vandoeuvre-Les-Nancy, France
b Department of Radiology, Centre Hospitalier Universitaire Nancy, Vandoeuvre-Les-Nancy, France
c Department of Paediatric Cardiology, Centre Hospitalier Universitaire Nancy, Vandoeuvre-Les-Nancy, France

* Address correspondence to Dr Vanhuyse, Departement de Pathologie Cardiaque, CHU Nancy, Rue du Morvan, 54500 Vandoeuvre-Les-Nancy, France

A male infant was born at term with a complex cardiopathy. A detailed cardiac ultrasound examination showed dextroisomerism, a total anomalous pulmonary connection with an unusual drainage pattern, a double-outlet right ventricle, and moderate pulmonary stenosis.

We performed cardiac computed tomography (CT) scanning to clarify the anatomy. The volume-rendered CT scan (Fig 1) shows the common pulmonary venous sinus (A) draining the 4 pulmonary veins. An ascending vertical vein (green arrow) connects to the left innominate vein, and a descending vertical vein (red arrow) connects to the portal vein. This demonstrates a rare total anomalous venous connection. All 4 pulmonary veins drained in a common pulmonary sinus connected through an ascending vertical vein to the left innominate vein and a descending vertical vein to the portal vein.


Figure 1
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  		Fig 1.
 
The patient was operated on, and we identified the pulmonary confluence. We made a parallel incision on the posterior wall of the left atrium and then created an anastomosis of the pulmonary confluence to the left atrium. Because of the pulmonary stenosis, we associated a Blalock Taussig shunt with a 3.5-mm Gore-Tex graft (W. L. Gore & Associates, Flagstaff, AZ). Unfortunately, septic shock developed at the fourth postoperative day and the patient died.

This image highlights the potential diagnostic utility of high-resolution computed tomography scanning in this difficult clinical situation.





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Jean Pierre Villemot
Loic Macé
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