Surgical technique
After performing a median sternotomy, cardiopulmonary bypass is established by aortobicaval cannulation. Immediately after the initiation of cardiopulmonary bypass, the ductus arteriosus or ligament is ligated. The patient is cooled to mild hypothermia at 28-30°C. The aorta is cross-clamped and cardiac arrest induced with antegrade cardioplegic solution.
The right pleural cavity is opened widely. The heart is retracted cephalad and pushed into the right pleural cavity exposing the posterior pericardial area.The vertical vein is ligated near its connection with the innominate vein or superior vena cava.The pulmonary vein confluence(PVC) is incised longitudinally until the individual ostias of pulmonary veins are exposed,but do not extend into the ostias. The anterior wall of the PVC is resected along the incision to form a window of the PVC(figure 1). The ostias of pulmonary veins are clearly visible from the window of the PVC. The left atrial appendage is retracted.In the supracardiac TAPVC the confluence is mostly transversal rather then vertical, therefore we resect part of the posterior wall of the left atrium to form a transverse rectangular window, corresponding to the window of the PVC(figure 2). The window of left atrium and the window of PVC are anastomosed using running suture with 7-0 polypropylene suture. The heart is put back into the mediastinum. The atrial septal defect is repaired using a bovin pericardium patch.
We had successfully treated 9 infants with supracardiac TAPVC using this surgical technique. All patients were discharged uneventfully.The median surgical age was 53 days [interquartile range (IQR): 32-92] days. The median body weight at surgery was 4.2 (IQR: 3.3-6.5) kg. The median time of CPB and aortic cross-clamp were 105 (IQR: 87-119) mins and 58 (IQR: 46-75) mins, respectively.The median follow-up was 7 months (range: 3 to 15 months). During the follow-up, no postoperative PVO was found in all patients, and all survivors were in New York Heart Association Functional Classification I or II.