title: Outcome of primary repair of infracardiac total anomalous pulmonary venous connection using a right-sided approach to the left atrium.
abstract: OBJECTIVE
  Pulmonary venous obstruction (PVO), the major postoperative complication in patients with infracardiac total anomalous venous connection (TAPVC), compromises the surgical outcomes of TAPVC repair. Here, we report our experience using a right-sided approach to the left atrium to repair this anomaly variant.
  
  
  METHODS
  Eleven patients with infracardiac TAPVC underwent this surgical modification from September 2005 to December 2009. After a medium sternotomy, bicaval venous cannulation was performed for cardiopulmonary bypass (CPB). By adequate exposure of the surgical field, incision of the left atrium was located and anastomosed to the corresponding incision in the pulmonary venous confluence through the right side. Medical records consisting of preoperative and postoperative data were retrospectively reviewed to analyze the efficiency of this strategy.
  
  
  RESULTS
  Total correction was achieved in all 11 patients and there were no operative deaths. Postoperative low cardiac output persisted in six patients (54.5%), including five patients with preoperative PVO. No late deaths were noted in a mean follow-up of 26.7 months (range, 1 to 51 months). Both residual atrial shunt and severe anastomotic obstruction were excluded by transthoracic echocardiography. Moderate residual obstruction was confirmed in one patient. At the end of the follow-up, all patients had normal biventricular function and were in New York Heart Association (NYHA) Functional Class I.
  
  
  CONCLUSIONS
  The right-sided approach for repair of infracardiac TAPVC contributes to produce favorable outcomes. This modified technique is useful for enhancing exposure during surgical repair and providing adequate patent anastomosis.
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Xu
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012587:Scimitar Syndrome / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*