title: Is vertical vein ligation necessary in repair of total anomalous pulmonary venous connection?
abstract: BACKGROUND
  In the repair of total anomalous venous connection, vertical vein ligation is recommended to eliminate left-to-right shunting. However, the small left heart chambers may not always tolerate the immediate increase in blood flow after combined repair and vein ligation.
  
  
  METHODS
  A retrospective review of 23 infants and children undergoing correction of total anomalous pulmonary venous connection was undertaken to determine whether vertical vein ligation is a necessary component of successful surgical repair. In 14 patients this vein was ligated, whereas in 9 it was left patent. Six patients who underwent ligation and 5 who did not had pulmonary venous obstruction before operation.
  
  
  RESULTS
  The operative mortality rate was 36% (5 of 14 patients) for the ligated group compared with 0% (0 of 9 patients) for the nonligated group (p = 0.06). All deaths occurred in patients with preoperative obstruction and a low mean left atrial pressure, and four of the deaths were directly attributable to left heart failure. Follow-up echocardiography in patients in whom the vertical vein was not ligated revealed adequate cardiac function and no residual left-to-right flow through the previously patent venous conduit.
  
  
  CONCLUSIONS
  Vertical vein ligation during the repair of total anomalous pulmonary venous connection is not routinely necessary and actually may be undesirable in patients with preoperative obstruction, in whom the left heart chambers are particularly small.
authors.affiliation: Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Cope
authors.forename: D
authors.initials: D
authors.lastname: Banks
authors.forename: N L
authors.initials: NL
authors.lastname: McDaniel
authors.forename: K S
authors.initials: KS
authors.lastname: Shockey
authors.forename: S P
authors.initials: SP
authors.lastname: Nolan
authors.forename: I L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D002675:Child, Preschool; D017023:Coronary Angiography; D006324:Heart Arrest, Induced; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008026:Ligation; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome