Bartkevics_Resident_competition_TAPVC.mp4 (346.57 MB)

Conventional Repair of Supracardiac Total Anomalous Pulmonary Venous Connection

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posted on 05.12.2019 by Maris Bartkevics, Peteris Rozitis, Damian Hutter, Paul Heinisch, Thierry Carrel, Alexander Kadner

This video illustrates the correction of supracardiac total anomalous pulmonary venous connection. The patient is an 11-year-old girl with a weight of 20 kg who was referred to the authors’ center in the context of a humanitarian project from Morocco. Echocardiography suggested supracardiac total anomalous pulmonary venous connection with a large atrial septal defect (ASD). A color Doppler test demonstrated a large vertical vein.

The patient was taken electively to the operating room. After full median sternotomy, the vertical vein was dissected free. After heparinization, bicaval cannulation was performed. During cooling to mild hypothermia, the pulmonary venous confluence posterior to the left atrium was dissected free. The aortic X – clamp was applied and low-volume crystalloid cardioplegia solution was given with immediate cardiac arrest.

The right atrium was opened with an incision using an 11 blade and extended with Metzenbaum scissors. The left atrium was inspected through the large ASD. The venous confluence was opened using an 11 blade, and incision extended with Metzenbaum scissors. At this point it is important not to extend the incision into the individual pulmonary vein orifices. This leads to a higher risk of pulmonary vein stenosis. The posterior wall of left atrium was opened at the corresponding level to the venous confluence. It is important that both incisions are made as parallel as possible. An anastomosis was fashioned between pulmonary confluence and the posterior wall of the left atrium. At this point, suturing must be performed with an inverting running suture line working inside at the pulmonary venous confluence and inside the left atrium. The anastomosis was completed with an inverting running suture in the same fashion. The tip of the sucker was used to check the individual pulmonary vein orifices. The ASD was closed with a bovine pericardial patch. The final adjustment of the patch was being made. The ASD closure was completed with a running suture. The right atrium was closed with a running paroxysmal depolarizing shift suture. The x–clamp was released and the heart started beating spontaneously. Pulmonary artery pressure was measured directly into the pulmonary trunk after completion of the operation and revealed normal pulmonary pressures. The drainages and pacing wires were placed in the standard fashion. Color doppler demonstrated a laminary flow at the site of anastomosis.

The patient made an uneventful postoperative recovery and was extubated six hours after surgery.




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