L -> R shunt: A serious consequence of TAPVC repair without ligation of vertical vein

It has been suggested that concomitant ligation of the vertical vein (VV) i s not necessary in the repair of total anomalous pulmonary venous connectio n. The patency of the VV is desirable in the presence of noncompliant left heart chambers that may not be able to accommodate acute increases in pulmo nary blood now, leading to hemodynamic instability after repair. Complete c essation of flow through the previously patent VV has been observed, obviat ing the need for a second-stage operation. We report 2 infants who were ope rated using this strategy, in which the VV continued to function as a condu it for a significant left to right shunt. (Ann Thorac Surg 2000;70:971-3) ( C) 2000 by The Society of Thoracic Surgeons.