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The Annals of Thoracic Surgery, Vol 27, 435-439, Copyright © 1979 by The Society of Thoracic Surgeons

ARTICLES

Late complications following surgical repair of total anomalous pulmonary venous return below the diaphragm

WH Fleming, EB Clark, KJ Dooley, PJ Hofschire, RN Ruckman, AR Hopeman, L Sarafian and PK Mooring

Between May, 1975, and June, 1977, we surgically repaired an infracardiac total anomalous pulmonary venous return in 4 infants under deep hypothermic cardiac arrest. All patients had pulmonary hypertension and a patent ductus arteriosus. All survived operation and required positive end-expiratory pressure with mechanical ventilation. Late complications included patent ductus arteriosus not visualized at initial catheterization, breakdown of an oversewn atrial septal defect repair, and pulmonary venous obstruction despite an anastomosis diamter of 1.5 to 2.5 cm. At reoperation, there was scarring and contraction at the junction of the pulmonary veins and left atrium. One infant with these complications died post-operatively. In another patient, there was kinking of the left lower pulmonary vein at its juncture with the left atrium. In view of these complications we currently recommend the following: ligation of the ductus arteriosus regardless of catheterization findings; a right-sided approach to avoid pulmonary vein kinking; prosthetic patch closure of the atrial septal defect to avoid excessive tension on suture lines and to maintain maximum left atrial size; stellate anastomosis to provide the largest possible drainage channel; awareness that an unusually high positive end- expiratory pressure may be required postoperatively; and early recatheterization.


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C. Mavroudis and R. M. Sade
The Southern Thoracic Surgical Association 50th anniversary celebration: the impact of STSA pediatric cardiothoracic surgery manuscripts on surgical practice
Ann. Thorac. Surg., November 1, 2003; 76(90050): S47 - 67.
[Abstract] [Full Text] [PDF]


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Copyright © 1979 by The Society of Thoracic Surgeons.