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This Article Full Text (PDF) 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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John J. Lamberti Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lamberti, J. J. Search for Related Content PubMed Articles by Lamberti, J. J. Related Collections Congenital - cyanotic Related Article

Ann Thorac Surg 2001;72:251
© 2001 The Society of Thoracic Surgeons

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Case report: invited commentary

Invited commentary

This report describes the outcomes of 2 patients undergoing repair of total anomalous pulmonary connection without the use of cardiopulmonary bypass. We reported a similar technique in 1984 [1]. In our report, both patients died late with a patent venous connection. Retrospective analysis of our data suggests that the venous connection was probably a bit small. One subsequent infant underwent emergent repair by our technique in 1991. At the time of the Fontan procedure in 1993, the restrictive pulmonary venous anastomosis was enlarged, the atrio-ventricular valve was repaired, and a total extracardiac conduit Fontan was performed. The patient is asymptomatic with no obvious exercise limitations at his last visit in July 2000. He has not undergone follow-up catheterization, nor has he required reoperation since the modified Fontan procedure.

We have not utilized this approach since 1991 because of our concerns regarding the long-term adequacy of the venous anastomosis. In this report, the authors suggest that an anastamosis between the pulmonary vein and the SVC/atrial junction may have better growth potential than a pulmonary vein-to-atrial wall anastamosis. The present report is anecdotal in nature as was our report in 1984. Combining the two reports with our subsequent experience reveals a midterm survival rate of 40%. The present report reminds us that the unusual anatomy present in some patients born with heterotaxy syndrome and obstructed pulmonary venous drainage may permit us to palliate a critically ill infant without exposing the baby to cardiopulmonary bypass, but there are not enough long-term data to suggest that this approach is appropriate for many patients.

References

1. Lamberti J.J., Waldman J.D., Methewson J.W., Kirkpatrick S.E. Repair of subdiaphragmatic total anomalous pulmonary venous connection without cardiopulmonary bypass. J Thorac Cardiovasc Surg 1984;88:627-630.

This Article Full Text (PDF) 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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John J. Lamberti Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lamberti, J. J. Search for Related Content PubMed Articles by Lamberti, J. J. Related Collections Congenital - cyanotic Related Article