Superior repair: A useful approach for some anatomic variants of total anomalous pulmonary venous connection

Abstract

Background: Total anomalous pulmonary venous connection (TAPVC) occurs when all the four pulmonary veins drain to the right atrium or to tributaries of the systemic veins. There have been various published techniques for the repair but none has been agreed on for the different anatomical variants that may be encountered during surgery.

Patients and Methods: Between January 2005 and June 2010 the data of 6 of 18 patients who had surgical repair using the superior approach were
retrospectively reviewed.Three patients had long narrow venous stalk connecting the coronary sinus to venous confl uence; two had the right  pulmonary veins draining to superior vena cava (SVC) and left pulmonary veins to left lateral wall of SVC and one had an obstruction at entrance of Pulmonary Vein into venous confl uence.

Results: Five patients initially had the superior approach while one had transatrial with unroofi ng of the coronary sinus. Two had a concomitant Wardens procedure. The mean aortic cross clamping was 87.5 (60-125) min, the mean cardiopulmonary bypass time should have min as unit of 127.8 (100-180), the mean Intensive Care Unit (ICU) stay of 2.5 (2-4)  days and the mean hospital stay 8.2 (7-9) days. One patient died at early
post-operation from low cardiac outputand five had an uneventful  post-operative course and had remained stable until date.

Conclusion: In our experience, the superior approach was an effective alternative approach for some anatomic variants of TAPVC that may be unexpectedly encountered during operation and also useful surgical  approach for older children.

Key words: Long venous stalk, pulmonary venous obstruction, superior approach, trans-atrial approach, warden’s procedure