title: Surgical outcome of isolated total anomalous pulmonary venous connection in adults: a 14-year experience.
abstract: OBJECTIVE
  To investigate the surgical result of adult total anomalous pulmonary venous connection (TAPVC).
  
  
  METHODS
  From March 1997 to March 2011, 12 adult cases of isolated TAPVC, with an average age of 24.9 ± 6.7 years (from 18 to 41 years), underwent surgical repair in our department. All patients suffered from right-sided volume overload with clinical manifestations varying from mild cyanosis to severe heart failure.
  
  
  RESULTS
  According to Darling's classification, eight cases were classified as supracardiac type, four as cardiac type. Unobstructed connections were established between the left atrium and the pulmonary common vein in all patients with external cardiac approach in four supracardiac cases, and internal cardiac approach in four cardiac and three supracardiac cases, and Warden technique in one supracardiac patient. Concomitant operations included De Vega's tricuspid annuloplasty in six patients, patent arteriosus ductus closure in two. All patients survived the operation, and postoperative follow-up was 100% complete with a period ranging from 10 months to 14 years. NYHA grade decreased from 2.33 ± 0.49 to 1.08 ± 0.29 (p < 0.01). Three patients had postoperative tricuspid insufficiency. Five patients had cardiac arrhythmia, among two symptomatic cases; one controlled with medication, another received a successful radiofrequency ablation for incision-related atrial flutter.
  
  
  CONCLUSIONS
  Surgical correction of isolated adult TAPVC can be carried out safely with acceptable long-term outcome. Postoperative tricuspid insufficiency and cardiac arrhythmias may have a negative long-term impact, which should be evaluated preoperatively and managed individually during surgery.
authors.affiliation: Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangzhou, PR China. jianxuhua@tom.com
authors.forename: Xu-hua
authors.initials: XH
authors.lastname: Jian
authors.forename: Jinsong
authors.initials: J
authors.lastname: Huang
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Ding
authors.forename: Xue-jun
authors.initials: XJ
authors.lastname: Xiao
authors.forename: Min
authors.initials: M
authors.lastname: Wu
authors.forename: Ji-mei
authors.initials: JM
authors.lastname: Chen
authors.forename: Jian
authors.initials: J
authors.lastname: Zhuang
mesh_terms: D000293:Adolescent; D000328:Adult; D013504:Cardiovascular Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012587:Scimitar Syndrome / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult