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.