OPERATIVE CORRECTION OF TOTAL LEFT ANOMALOUS PULMONARY VENOUS RETURN WITHOUT ATRIAL SEPTAL DEFECT

Abstract

The evaluation, surgical repair and follow up are described for an asymptomatic 5-year-old girl with unilateral total anomalous pulmonary venous return from the left lung through the innominate vein without atrial septal defect (ASD). Although the patient had not any symptoms except faint heart murmur with Qp/Qs 1.5 and L→R shunt 36%, the correction was completed, because the disease in the right normal lung could become fatal. The anomalous vein was divided and anastomosed directly to the LA_??_LA appendage. The anastomosed area was made widely with 5-0 Polydioxanone (PDS) continuous and interrupted suture under cardioplegic arrest with extracorporeal circulation. The postoperative course was uneventful and an excellent hemodynamic result was confirmed by postoperative angiogram. Partial anomalous pulmonary venous return itself is not so rare disease, but it often occurs as the anomalous return of the right pulmonary vein and most cases of the diseases are associated with ASD. Total left anomalous pulmonary venous return like this case is so rare that only 14 cases have been reported in the Japanese literature as far as we could review. This case appears the 6th report in Japan, if we review such cases without ASD.