Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava Atsushi Nakahira, MD, Toshikatsu Yagihara, MD, Koji Kagisaki, MD, Ikuo Hagino,

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Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava Atsushi Nakahira, MD, Toshikatsu Yagihara, MD, Koji Kagisaki, MD, Ikuo Hagino, MD, Toru Ishizaka, MD, Masahiro Koh, MD, Hideki Uemura, MD, Soichiro Kitamura, MD The Annals of Thoracic Surgery Volume 82, Issue 3, Pages 978-982 (September 2006) DOI: 10.1016/j.athoracsur.2006.02.013 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Schemata of partial anomalous pulmonary venous connections to the high portion of the superior vena cava (A), repair using the Warden method (B), and modified Warden method with pedicled autologous pericardial flap as an anterior augmentation of the SVC channel (C). (ASD = atrial septal defect; LA = left atrium; RA = right atrium; SVC = superior vena cava.) The Annals of Thoracic Surgery 2006 82, 978-982DOI: (10.1016/j.athoracsur.2006.02.013) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Schemata of preoperative (A) and postoperative (B) findings for the 2 patients with SVC obstruction who had persistent left SVC, which was larger than the right SVC with a good communicating vein. (LA = left atrium; PLSVC = persistent left superior vena cava; RA = right atrium.) The Annals of Thoracic Surgery 2006 82, 978-982DOI: (10.1016/j.athoracsur.2006.02.013) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Height index is defined as the length (X) between the cephalic end of the highest anomalous pulmonary venous orifice and the SVC-RA junction divided by the height (Y) of the vertebra at the same level as the junction, and can be determined using the preoperative catheterization images. (SVC = superior vena cava; RA = right atrium.) The Annals of Thoracic Surgery 2006 82, 978-982DOI: (10.1016/j.athoracsur.2006.02.013) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Relationship between height index and postoperative SVC flow on echocardiography and the pressure gradient in the SVC channel on catheterization. Excluding two patients with no blood flow in the cavoatrial channel due to cavoatrial occlusion, the data for eighteen patients have been plotted. R is the coefficient correlation between the height index and SVC flow, and between the index and pressure gradient through cavoatrial anastomosis, respectively, in each figure. (♦ = intervention group; SVC = superior vena cava; PG = pressure gradient; RA = right atrium.) The Annals of Thoracic Surgery 2006 82, 978-982DOI: (10.1016/j.athoracsur.2006.02.013) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Height indices in the three groups of patients: (a) two asymptomatic patients, both of whom were incidentally found to have SVC occlusion on postoperative SVC angiography and had persistent left SVC, which was larger than the right SVC, with a good communicating vein between them; (b) patients who did not have any symptom nor need any additional intervention; and (c) patients who required catheter intervention in the cavoatrial anastomosis. (SVC = superior vena cava.) The Annals of Thoracic Surgery 2006 82, 978-982DOI: (10.1016/j.athoracsur.2006.02.013) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions