Left-Sided Partial Anomalous Pulmonary Venous Connections

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Presentation transcript:

Left-Sided Partial Anomalous Pulmonary Venous Connections Andrew W. ElBardissi, BS, Joseph A. Dearani, MD, Rakesh M. Suri, MD, DPhil, Gordon K. Danielson, MD The Annals of Thoracic Surgery Volume 85, Issue 3, Pages 1007-1014 (March 2008) DOI: 10.1016/j.athoracsur.2007.11.038 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Exposure of left-sided partial anomalous pulmonary venous connections. An anterolateral thoracotomy through the left fourth intercostal space is carried out with the left lung deflated and a ratcheted retractor is placed (A). The pericardium is opened posterior to the phrenic nerve and retracted anteriorly with 2-0 silk stay sutures (B) and (C). The Annals of Thoracic Surgery 2008 85, 1007-1014DOI: (10.1016/j.athoracsur.2007.11.038) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Left-sided partial anomalous pulmonary venous connection operative technique. A Satinsky clamp is placed just below the insertion of the vertical vein into the innominate vein and a small bulldog clamp is placed at least 4 cm proximally on the vertical vein (A). The vertical vein is transected and the vertical vein-innominate confluence is repaired using 4-0 or 5-0 prolene (B). Stay sutures are placed at the superior and inferior margins, and the back wall of the anastomosis is created using a running 5-0 prolene suture (C). Stay sutures are removed and the anterior wall anastomosis is performed using interrupted stitches (D). The clamp on the proximal vertical vein is removed and air is aspirated with fine needle, after which the left atrial appendage clamp and the left pulmonary artery clamps are removed in sequence (E) and (F). The Annals of Thoracic Surgery 2008 85, 1007-1014DOI: (10.1016/j.athoracsur.2007.11.038) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Age distribution at time of presentation. The Annals of Thoracic Surgery 2008 85, 1007-1014DOI: (10.1016/j.athoracsur.2007.11.038) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Linear regression model of age versus year of surgery. The Annals of Thoracic Surgery 2008 85, 1007-1014DOI: (10.1016/j.athoracsur.2007.11.038) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Anatomic variations of left-sided anomalous pulmonary veins. (ASD = atrial septal defect.) The Annals of Thoracic Surgery 2008 85, 1007-1014DOI: (10.1016/j.athoracsur.2007.11.038) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Time to rehospitalization due to cardiac causes. The Annals of Thoracic Surgery 2008 85, 1007-1014DOI: (10.1016/j.athoracsur.2007.11.038) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions