Adjustable suture of the vertical pulmonary vein for repair of infracardiac total anomalous pulmonary venous connection.

The results of repair of total anomalous pulmonary venous connection (TAPVC) have dramatically improved over recent years) However, a higher mortality and morbidity still remain significant in patients less than 3 months of age who have right-sided hypertension, pulmonary venous obstruction, and low volume in the left side of the heart. 2" 3 Postoperative low cardiac output may persist because of a small and noncompliant left atrium and ventricle or episodes of reactive pulmonary hypertension. Several surgical techniques have been suggested to reconstruct an unrestrictive wide connection between the left atrium and pulmonary veins, as this connection will allow the left side of the heart time to adapt and maintain cardiac output . 4 Most authors suggest ligation or interruption of the vertical vein just above the diaphragm, although the authors of a past report 5 were concerned about the occurrence of acute liver necrosis immediately after the operation. We believe that leaving an adjustable suture during the immediate postoperative period may be useful for venting of the left ventricle, especially if low cardiac output persists despite the creation of an wide left atrium-pulmonary vein anastomosis. A 4-week-old infant weighing 2 kg was admitted because of increasing cyanosis, pulmonary edema, and hepatomegaly. Two-dimensional echocardiography with Doppler and color flow mapping study and cardiac catheterization demonstrated infracardiac type TAPVC with the portal system. The operation was performed with profound hypothermia and circulatory arrest (31 minutes). The repair was carried out by a wide anastomosis between the common pulmonary vein, with the incision being extended into the upper right pulmonary vein and the posterior left atrial wall.