title: Direct implantation of scimitar vein to the left atrium via sternotomy: a reappraisal.
abstract: OBJECTIVE
  There is no consensus about optimal surgical technique for the repair of scimitar vein, an anomalous right pulmonary venous connection to the inferior vena cava. Our current experience with a direct anastomosis of the scimitar vein to the left atrium via sternotomy may be shared with other centres, but has not been widely published.
  
  
  METHODS
  Six consecutive patients (age 6 months to 17 years, mean 5 years) operated on in 2009-12 were retrospectively reviewed. Through median sternotomy and with cardiopulmonary bypass, the mobilized anomalous right pulmonary vein was brought through a large pericardial opening posterior to the right phrenic nerve and anastomosed onto the right side of the posterior left atrium with access via an existing or a surgically created atrial septal defect.
  
  
  RESULTS
  Five patients had primary venous repair and one had a previous failed repair using an intra-atrial baffle. The median cardiopulmonary bypass and cross-clamp times were 88 and 38 min, respectively. The median ventilator time was 1 day and the median stay at the intensive care unit 3.5 days. There were no deaths within a median follow-up of 28 months (range 8-41 months), nor reoperations or instances of pulmonary venous obstruction.
  
  
  CONCLUSIONS
  Anatomic repair of the scimitar vein based on reimplantation onto the left atrium via sternotomy is conceptually appealing. The surgery results in a safe and reliable repair in patients with a wide age spectrum. Durability needs on-going assessment in longer-term follow-up.
authors.affiliation: Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Hanna
authors.initials: H
authors.lastname: Jensen
authors.affiliation: Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Muthialu
authors.affiliation: Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Furci
authors.affiliation: Department of Cardiology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Yates
authors.affiliation: Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Kostolny
authors.affiliation: Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK victor.tsang@gosh.nhs.uk.
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
mesh_terms: D000293:Adolescent; D002315:Cardiopulmonary Bypass; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D012587:Scimitar Syndrome / Q000601:surgery*; D056346:Sternotomy / Q000379:methods*
keywords: Congenital heart disease; Lung/congenital lesions; Pulmonary arteries/veins; Surgery/techniques