211285 A modification of surgical procedure for infracardiac total anomalous pulmonary venous connection

/Xu Zhiwei(徐志偉，Dept Thorac Cardiovasc Surg，Shanghai Children’s Med Center，Shanghai Jiaotong Univ，Shanghai 200127)…∥Chin J Thorac Cardiovasc Surg.-2011，27(3).-155～157

ObjectiveInfracardiac total anomalous pulmonary venous connection，a rare congenital cardiac defect，is associated with high mortality.A modification was designed for the procedure to reduce the post-operative obstruction in the pulmonary vena.MethodsFrom September 2005 to December 2007，seven patients with infracardiac total anomalous pulmonary venous connection were treated with repair surgery through right side approach.The patients’age at operation was(70.57 ±44.67)days，the weight was(4.07 ±0.87)kg.Three patients had pulmonary venous obstruction，and 2 with small PFO.A modified rightside approach for repairing this defect was used.ResultsNo death occurred after the operation.The postoperative complications included low cardiac output in 5 patients(71.43%)，pulmonary hypertension crisis in 3 patients(42.86%)，mechanical ventilation for more than 7 days，which happened in 2 patients(28.58%)and pulmonary infection.All of the patients received follow-up.No residual shunt and pulmonary venous return obstruction were identified on echocardiogram(with a velocity from 1.2 m/s to 1.47 m/s).The heart function of patients was within thenormalrange(EF 0.70-0.79， FS 0.32-0.44).ConclusionThe modified surgical procedure for the correction of infracardiac total anomalous pulmonary venous connection by right side approach was associated with favorite clinical outcomes，The post-operative outcomes depended on the size of anastomosis between the common vein and left atrium and the patency of the pulmonary venous return.Adequate size of anastomosis and maintenance of the spatial structures in adjacent regions were helpful in decreasing the adverse effect of postoperative obstruction.4 refs，2 figs.