title: Mixed type total anomalous pulmonary venous connection: early results and surgical techniques.
abstract: BACKGROUND
  The mixed total anomalous pulmonary connection is a rare type of congenital cardiopathy. The occurrence of multiple connections of the pulmonary veins has important implication in the diagnosis and surgical planning. These types of total anomalous pulmonary venous connection (TAPVC) and the infracardiac have higher surgical mortality.
  
  
  METHODS
  Between December 1994 and July 2013, a total of 58 children underwent surgical treatment of TAPVC. Twenty-five (43.1%) patients had supracardiac connection, 15 (25.8%) patients had intracardiac type, 12 (20.6%) patients had a mixed type, and 6 (10.3%) patients had an infracardiac type. In children with mixed TAPVC, four (33.3%) patients had type I, five (41.6%) patients had type II, and three (25.0%) patients had type III. The diagnosis of TAPVC was performed in all patients using Doppler echocardiography, and they underwent cardiopulmonary bypass with aorta-bicaval cannulation and lately we use mild hypothermia with normal flow. The drainage channels were ligated in all patients.
  
  
  RESULTS
  The immediate surgical results were as follows: one (16.6%) death in the infracardiac group, four (16.0%) deaths in the supracardiac group, one (8.3%) death in the mixed group, and no death in the cardiac group (no statistical difference, P = .488).
  
  
  CONCLUSIONS
  In this series of patients, the mixed TAPVC could be corrected only with preoperative two-dimensional Doppler echocardiography with good immediate results, and we believe that the use of computed angiotomography combined with three-dimensional reconstruction may improve the surgical outcome mainly in the mixed and infracardiac group of TAPVC.
authors.affiliation: Furlanetto Institute, São Paulo, Brazil furlanettoglaucio@gmail.com.
authors.forename: Gláucio
authors.initials: G
authors.lastname: Furlanetto
authors.affiliation: Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil.
authors.forename: Beatriz H S
authors.initials: BH
authors.lastname: Furlanetto
authors.affiliation: Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil.
authors.forename: Sandra R C
authors.initials: SR
authors.lastname: Henriques
authors.affiliation: Real e Benemérita Associação Portuguesa, São Paulo, Brazil.
authors.forename: Lilian M
authors.initials: LM
authors.lastname: Lopes
authors.affiliation: Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil.
authors.forename: Eduardo T
authors.initials: ET
authors.lastname: Miranda
authors.affiliation: Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil.
authors.forename: Carolina M G
authors.initials: CM
authors.lastname: Porto
authors.affiliation: Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil.
authors.forename: Maria Emilia N T
authors.initials: ME
authors.lastname: Pereira
authors.affiliation: Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil.
authors.forename: Claudia
authors.initials: C
authors.lastname: Davini
authors.affiliation: Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil.
authors.forename: Elssi C
authors.initials: EC
authors.lastname: Espinosa
mesh_terms: D000015:Abnormalities, Multiple / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000401:mortality / Q000601:surgery*
keywords: congenital heart disease (CHD); congenital heart surgery; neonate; pediatric