CORRECTION OF TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION OF THE CARDIAC TYPE

Surgical treatment of the cardiac type of total anomalous pulmonary ve nous connection requires special techniques, The treatment and outcome in 17 consecutive patients who had undergone primary repairs of the c ardiac type between 1965 and 1996 were reviewed, The median age was 3 months and median weight 4.2 kg, The connection was the coronary sinus in ten patients, and the right atrium in six, Interatrial communicati on was routinely augmented, The right atrial cavity was partitioned us ing a patch to direct the anomalous pulmonary veins into the left atri um through the atrial septal defect in the first 13 patients. In the l ast four patients, the free wall flap of the right atrium was develope d as a neoseptum, There were three early postoperative deaths during t he early period of conventional repair. Two patients developed residua l or recurrent diffuse obstruction in the individual lobar veins; reop eration to relieve the obstruction was attempted but unsuccessful. One sudden death occurred in a patient with occasional heart block. Ten s urvivors have been asymptomatic during followup, but two incomplete he art blocks and one atrial flutter were noted among patients who underw ent conventional repair. The right atrial wall flap technique was not associated with any mortality or morbidity, such as arrhythmia and rec urrent pulmonary vein stenosis during 12 to 63 months of postoperative obstruction. In conclusions, a flap technique using the right atrial wall appears to be a promising method to decrease the incidence of sup raventricular arrhythmias and pulmonary vein drainage obstruction foll owing repair of the cardiac type. (C) 1998 The International Society f or Cardiovascular Surgery.