Repair of Unusual Types of Total Anomalous Pulmonary Veins

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Repair of Unusual Types of Total Anomalous Pulmonary Veins Duke E. Cameron  Operative Techniques in Thoracic and Cardiovascular Surgery  Volume 6, Issue 1, Pages 50-57 (February 2001) DOI: 10.1053/otct.2001.24704 Copyright © 2001 Elsevier Inc. Terms and Conditions

1 Patterns of pulmonary vein discontinuity and mixed drainage in unusual forms of TAPV drainage (based on the series by Bharati and Lev).2 (A) Left upper (LUL) vein to innominate vein via left vertical vein (LVV), all other veins to coronary sinus (CS). (B) Both left veins to innominate, right veins to coronary sinus. (C) Both left veins to innominate, both right veins to inferior vena cava (IVC). (D) Both upper veins confluent but no drainage, both lower veins to IVC. (E) Both left veins and right lower vein to coronary sinus, right upper vein to superior vena cava (SVC). (F) Both right veins to SVC, both left veins to coronary sinus. (G) Both left veins to innominate, both right veins to portal vein. (II) All veins to IVC, hypoplastic left vertical vein. (1) All veins confluent, with dual connection to right atrium and innominate vein. (J) Both lower veins drain separately to infradiaphragmatic veins, left upper vein to innominate, and right upper vein to SVC. Operative Techniques in Thoracic and Cardiovascular Surgery 2001 6, 50-57DOI: (10.1053/otct.2001.24704) Copyright © 2001 Elsevier Inc. Terms and Conditions

2 Establishment of pulmonary venous confluence by anastomosis of left and right pulmonary veins in infradiaphragmatic drainage. Operative Techniques in Thoracic and Cardiovascular Surgery 2001 6, 50-57DOI: (10.1053/otct.2001.24704) Copyright © 2001 Elsevier Inc. Terms and Conditions

3 When drainage is intracardiac or mixed, establishment of pulmonary venous confluence and interruption of the anomalous drainage are followed by intracardiac repair as described elsewhere in this volume. In repair of intracardiac TAPV, the “septum” between the left atrium and the coronary sinus is excised and a large pericardial patch is sewn over both ostia. Operative Techniques in Thoracic and Cardiovascular Surgery 2001 6, 50-57DOI: (10.1053/otct.2001.24704) Copyright © 2001 Elsevier Inc. Terms and Conditions

4 Repair of anomalous right pulmonary veins. The vein orifices are baffled to the atrial septal defect. Operative Techniques in Thoracic and Cardiovascular Surgery 2001 6, 50-57DOI: (10.1053/otct.2001.24704) Copyright © 2001 Elsevier Inc. Terms and Conditions

5 When the left upper pulmonary veins are the sole anomalous veins or when they are discontinuous with other veins and not easily unifocalized with them, a separate anastomosis of these veins can be performed to the left atrial appendage. Operative Techniques in Thoracic and Cardiovascular Surgery 2001 6, 50-57DOI: (10.1053/otct.2001.24704) Copyright © 2001 Elsevier Inc. Terms and Conditions