Is Vertical Vein Ligation Necessary in Repair of Total Anomalous Pulmonary Venous Connection? Jeffrey T Cope, David Banks, Nancy L McDaniel, Kimberly.

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Is Vertical Vein Ligation Necessary in Repair of Total Anomalous Pulmonary Venous Connection? Jeffrey T Cope, David Banks, Nancy L McDaniel, Kimberly S Shockey, Stanton P Nolan, Irving L Kron The Annals of Thoracic Surgery Volume 64, Issue 1, Pages 23-29 (July 1997) DOI: 10.1016/S0003-4975(97)00452-9

Fig. 1 Angiographic images obtained during levophase after pulmonary artery injection in a child with type III total anomalous pulmonary venous return, in whom the descending vertical vein was not ligated at the time of repair. (A) Preoperative angiogram demonstrating an anomalous descending vertical vein to the portal system. The arrow indicates the site of obstruction at the level of the diaphragm. (B) Angiographic image obtained 43 months after the operation revealing normal filling of the left atrium (open arrow) and only the uppermost portion of the unligated vertical vein (solid arrow). The remaining portion of the vein has undergone spontaneous closure. The Annals of Thoracic Surgery 1997 64, 23-29DOI: (10.1016/S0003-4975(97)00452-9)

Fig. 2 Angiographic studies performed in a patient with mixed total anomalous pulmonary venous return and a descending vertical venous component, in whom the latter was left open during the operation. (A) Preoperative anteroposterior view of the descending vein (arrow). (B) Anteroposterior image obtained 32 days after operation, disclosing persistent patency of the unligated vein (arrow). (C) Lateral projection revealing a stricture at the common pulmonary vein-to-left atrium anastomosis (solid arrow), accounting for failure of the vertical vein (open arrow) to undergo spontaneous closure. The Annals of Thoracic Surgery 1997 64, 23-29DOI: (10.1016/S0003-4975(97)00452-9)

Fig. 2 Angiographic studies performed in a patient with mixed total anomalous pulmonary venous return and a descending vertical venous component, in whom the latter was left open during the operation. (A) Preoperative anteroposterior view of the descending vein (arrow). (B) Anteroposterior image obtained 32 days after operation, disclosing persistent patency of the unligated vein (arrow). (C) Lateral projection revealing a stricture at the common pulmonary vein-to-left atrium anastomosis (solid arrow), accounting for failure of the vertical vein (open arrow) to undergo spontaneous closure. The Annals of Thoracic Surgery 1997 64, 23-29DOI: (10.1016/S0003-4975(97)00452-9)