MIXED-TYPE OF TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION

Background. The mixed type of total anomalous pulmonary venous connect ion is a rare condition in which some diagnostic and surgical problems still remain to be solved. Methods. In 9 patients a single pulmonary vein was connected to the systemic vein at a site different from the d rainage site of the confluence of three other pulmonary veins. In 2 ot her patients, four pulmonary veins made a confluence which had two dra inage sites. Correct diagnosis was made in all 7 patients who received cardiac catheterization but only in 5 of the 9 patients by color Dopp ler echocardiography. Total correction was performed in 3 patients and the single anomalous pulmonary vein was left uncorrected in 8 other p atients. Results. There were two in-hospital deaths. Seven patients wi th a single residual anomalous pulmonary vein have been in good condit ion without clinical symptoms of congestive heart failure or pulmonary hypertension. Conclusions. Diagnosis of mixed type of total anomalous pulmonary venous correction by echocardiography is sometimes difficul t. When a mixed type is suspected, cardiac catheterization is recommen ded if the condition of the patient permits it. A single anomalous pul monary vein may be left uncorrected without serious complications, but close observation is needed to prevent congestive heart failure and p ulmonary vascular obstructive disease. (Ann Thorac Surg 1998;66:1394-7 ) (C) 1998 by The Society of Thoracic Surgeons