Mixed total anomalous pulmonary venous connection: Anatomic variations, surgical approach, techniques, and results Ujjwal K. Chowdhury, MCh, Diplomate.

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Mixed total anomalous pulmonary venous connection: Anatomic variations, surgical approach, techniques, and results Ujjwal K. Chowdhury, MCh, Diplomate NB, Balram Airan, MCh, Amber Malhotra, MS, Akshay K. Bisoi, MCh, Anita Saxena, DM, Shyam S. Kothari, DM, FACC, Mani Kalaivani, MSc. (Biostatistics), Panangipalli Venugopal, MCh The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 1, Pages 106-116.e5 (January 2008) DOI: 10.1016/j.jtcvs.2007.08.028 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A to D, Group of patients with bilateral and symmetrical connections (“2+2” pattern of drainage). BCV, Brachiocephalic vein; CS, coronary sinus; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RA, right atrium; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; SVC, superior vena cava; VV, vertical vein. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 106-116.e5DOI: (10.1016/j.jtcvs.2007.08.028) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A to F, Group of patients with bilateral and asymmetrical connections (“3+1” pattern of drainage). For abbreviations, see Figure 1. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 106-116.e5DOI: (10.1016/j.jtcvs.2007.08.028) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A to E, Group of patients of bizarre anatomic variants of mixed total anomalous pulmonary venous connection. CC, Common chamber; RCPV, right common pulmonary vein; RMPV, right main pulmonary vein. For other abbreviations, see Figure 1. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 106-116.e5DOI: (10.1016/j.jtcvs.2007.08.028) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 A to D, Diagrammatic representation of the steps of vertical vein–left atrial appendage anastomosis avoiding tension, torsion, and rotation. BCV, Brachiocephalic vein; LAA, left atrial appendage; LPA, left pulmonary artery; LSPV, left superior pulmonary vein; VV, vertical vein. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 106-116.e5DOI: (10.1016/j.jtcvs.2007.08.028) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Two-dimensional and Doppler echocardiogram of a patient with mixed total anomalous pulmonary venous connection showing left upper pulmonary vein (LUPV) entering the left atrial appendage (LAA) with nonturbulent, biphasic pulmonary venous flow from the LUPV to the LAA. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 106-116.e5DOI: (10.1016/j.jtcvs.2007.08.028) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 A and B, Computed tomographic angiogram of a patient with mixed total anomalous pulmonary venous connection 5 years postoperatively showing a patent, unrestricted vertical vein–left atrial appendage (LAA) anastomosis. This figure also shows a polytetrafluoroethylene baffle between the left atrium (LA) and right atrium (RA). CC, Common chamber; LUPV, left upper pulmonary vein. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 106-116.e5DOI: (10.1016/j.jtcvs.2007.08.028) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Actuarial survival curve (Kaplan–Meier) of three categories of patients with mixed total anomalous pulmonary venous connection undergoing rechanneling of the same in the study group. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 106-116.e5DOI: (10.1016/j.jtcvs.2007.08.028) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions