title: Mixed total pulmonary venous drainage: still a surgical challenge.
abstract: OBJECTIVE
  The aim of this report is to review the surgical experience of a single institution with a relatively large series of patients with mixed total pulmonary venous drainage.
  
  
  METHODS
  Between January 1, 1971, and December 31, 1994, 232 patients with total pulmonary venous drainage underwent surgical correction. Twenty of these patients (8.6%) had mixed type total pulmonary venous drainage. Ages at operation ranged from 1 day to 46 months, with a median of 2.3 months.
  
  
  RESULTS
  Both cardiac catheterization and echocardiography were performed before operation in 12 patients. Four patients underwent only cardiac catheterization, and another four patients underwent only echocardiography. The sensitivity and specificity for catheterization were 94% and 99%, respectively; they were 31% and 100%, respectively, for echocardiography. Severe pulmonary venous obstruction was present in three patients, all of whom underwent emergency operation. Three patients (15%), all of whom had preoperative pulmonary venous obstruction, died after operation. There were two late deaths, one of pulmonary vein stenosis and the other of probable pulmonary hypertension. The actuarial survival at 10 years was 73% for all patients; patients who survived the initial operation had a 10-year survival of 87%.
  
  
  CONCLUSIONS
  The diagnosis of mixed total pulmonary venous drainage can be difficult to establish by echocardiography or at the time of operation. For patients in stable condition, cardiac catheterization may be considered if fewer than three pulmonary veins are identified by echocardiography. Pulmonary venous obstruction is relatively infrequent in this group of patients but when present impacts patient survival significantly. The long-term results with this lesion are excellent.
authors.affiliation: Great Ormond Street Hospital NHS Trust, London, United Kingdom.
authors.forename: R E
authors.initials: RE
authors.lastname: Delius
authors.forename: M R
authors.initials: MR
authors.lastname: de Leval
authors.forename: M J
authors.initials: MJ
authors.lastname: Elliott
authors.forename: J
authors.initials: J
authors.lastname: Stark
mesh_terms: D000206:Actuarial Analysis; D006328:Cardiac Catheterization; D002675:Child, Preschool; D004452:Echocardiography; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome