Repair of Supracardiac Total Anomalous Pulmonary Venous Return

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Repair of Supracardiac Total Anomalous Pulmonary Venous Return Irving Shen, Ross M. Ungerleider Operative Techniques in Thoracic and Cardiovascular Surgery Volume 6, Issue 1, Pages 8-11 (February 2001) DOI: 10.1053/otct.2001.23175 Copyright © 2001 Elsevier Inc. Terms and Conditions

1 Our preferred approach is to lift the apex of the heart up out of the pericardial well toward the patient's right shoulder, providing exposure to the posterior left atrium and the posterior pericardium.6 Occasionally, a pledgeted suture placed through the apex of the left ventricle provides a convenient “handle” for retraction. The pulmonary vein confluence is exposed through an opening in the posterior pericardium. An incision is made in the pulmonary venous confluence from the right to the left pulmonary veins extending, when feasible, slightly into each individual pulmonary vein to ensure as large an anastomosis as possible and to minimize the risk of anastomotic stenosis. A corresponding incision is made in the posterior left atrium and left atrial appendage that matches the incision in the pulmonary venous confluence. (Reprinted with permission.6) Operative Techniques in Thoracic and Cardiovascular Surgery 2001 6, 8-11DOI: (10.1053/otct.2001.23175) Copyright © 2001 Elsevier Inc. Terms and Conditions

2 The left atrial incision is anastomosed to the opening in the pulmonary venous confluence using continuous monofilament suture. Even though it is possible to close the interatrial communication through the left atrial incision, it is often easier to do so through a right atrial opening. This can be done after finishing the left atrial anastomosis by making a separate right atriotomy. (Reprinted with permission.6) Operative Techniques in Thoracic and Cardiovascular Surgery 2001 6, 8-11DOI: (10.1053/otct.2001.23175) Copyright © 2001 Elsevier Inc. Terms and Conditions

3 After the interatrial communication is closed, cardiopulmonary bypass is restarted and the patient is rewarmed back to normal body temperature before weaning off bypass. During the rewarming phase of bypass, the vertical vein is double-ligated with silk suture as close as possible to its connection to the innominate vein. Modified ultrafiltration is helpful after termination of cardiopulmonary bypass to improve postoperative pulmonary compliance and left ventricular performance. A pulmonary artery catheter is usually placed for postoperative monitoring, because pulmonary hypertension is common in these patients. (Reprinted with permission.6) Operative Techniques in Thoracic and Cardiovascular Surgery 2001 6, 8-11DOI: (10.1053/otct.2001.23175) Copyright © 2001 Elsevier Inc. Terms and Conditions