RECOGNITION AND MANAGEMENT OF OBSTRUCTED PULMONARY VEINS DRAINING TO THE CORONARY SINUS

Background. Obstruction of the pulmonary veins in total anomalous pulm onary venous drainage to the coronary sinus is generally considered ra re. However, if it is present, the usual treatment of unroofing the co ronary sinus will lead to a poor result. Methods. Four patients with t otal anomalous pulmonary venous drainage to the coronary sinus with ob struction were identified over a 14-month period. Three patients in wh om the diagnosis of obstruction was not made underwent coronary sinus woofing. Retrospective review of the preoperative echocardiograms and Doppler studies showed the presence of obstruction in the vertical vei n in 2 patients and in the branches in the other. In the fourth patien t, obstruction in the vertical vein was recognized preoperatively with echocardiography and Doppler study. This patient underwent direct com mon pulmonary vein-left atrial anastomosis. Results. All 3 patients wh o had coronary unroofing were seen with obstructed pulmonary veins 2 t o 7 months postoperatively. After reoperation, 1 died, and the other 2 have done relatively well 3 1/2 and 15 months postoperatively. The pa tient who had an anastomosis between the common pulmonary vein and the left atrium is doing well 18 months postoperatively. Conclusions. Obs truction in total anomalous pulmonary venous drainage to the coronary sinus is not as rare as previously reported. To improve outcome, its p resence should be sought using complete echocardiography including Dop pler studies. When obstruction is present, transection of the vertical vein and common pulmonary vein-left atrial anastomosis through the su perior approach is an attractive technique that also eliminates the ri ght-to-left shunting associated with coronary sinus unroofing and simp lifies closure of the atrial septal defect. (C) 1997 by The Society of Thoracic Surgeons.