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Superior Approach for Correction of the Supracardiac Type of Total Anomalous Pulmonary Venous Drainage

Wednesday, December 9, 2020

Pardo CAP, Perez-Caballero R, Pita A, Gil-Jaurena J-M. Superior Approach for Correction of the Supracardiac Type of Total Anomalous Pulmonary Venous Drainage. December 2020. doi:10.25373/ctsnet.13353440

This video describes a superior approach for the correction of the supracardiac type of total anomalous pulmonary venous drainage (TAPVD) in a 2.8 kg newborn with a small patent foramen ovale (PFO).

Surgical Technique:
Through the standard median sternotomy, the great vessels were fully mobilized and the right pulmonary artery was surrounded with a vessel loop. The aorta and right atrium were cannulated and cardiopulmonary bypass (CPB) was established, and cooling to 18 ºC was accomplished. Patent ductus arteriosus (PDA) was ligated and the persistent vertical vein (PVV) was identified and surrounded with a tie but not occluded. The ascending aorta was clamped and cardiac arrest achieved by antegrade crystalloid cardioplegia. The ascending aorta was transected and the pulmonary artery was mobilized to the left side, leaving an excellent exposure thought the transverse sinus of the common pulmonary venous trunk (CPVT) and the superoposterior aspect of the left atrium (LA).

Total circulatory arrest was started and the venous cannula was removed to obtain optimal exposure. The tie about the PVV was pulled up to occlude it. A parallel incision was made along the CPVT, and the left atrial appendage was completely removed and the incision was enlarged towards the right atrium. A large anastomosis was fashioned between the two structures using a locking continuous suture line with 7/0 polypropylene. The PFO was left open. The CPB was re-established and an end-to-end anastomosis was performed in the ascending aorta. The PVV was tied off and the chest was closed in routine fashion.


  • The superior approach through the transverse sinus affords excellent exposure of the pulmonary venous trunk and left atrium.
  • Appendage removal ensures a wide anastomosis and prevents a likely compression.
  • Although not necessary, aortic transection can help an exposure. Alternatively, a tape around the transverse sinus shifts both aorta and pulmonary artery to the left side.


Tucker BL, Lindesmith GG, Stiles QR, Meyer BW. The superior approach for correction of the supracardiac type of total anomalous pulmonary venous return. Ann Thorac Surg. 1976; 22:374-377.


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Congratulations for Your presentation. What was the clinical presentation of the neonate? Was it obstruction? Was the ascending vein getting compressed between the PA and the Bronchus??? I understand that you transect the LA appendage as you want to achieve a wide anastomosis, but this is also determined by the incision on the collector chamber of the veins. I guess that transection of the LA appendage on its base will help on opening up the anastomosis on the veins end, but also possibly will be adding some tension on the cardiac end. Would you ever consider leaving the Vertical vein open, so it can act as a L-->R shunt in case of late anastomotic problems? Provided you decide to ligate the vein, why not also divide it, so PV veins really 'drop' more inferiorly. What was the rational on leaving a PFO open (if you have closed the vertical vein)? Well Done for Your work, and thank you for sharing your video. Allow me to post my comments and questions towards Your Team. Thank you. George
I appreciate your kind comments, George. Certainly, left appendage severing provides a wide anastomosis, which is the rationale of this presentation. We have found this technique simple and reproducible, with no tension as you wisely point out. Vertical vein is routinely ligated in our practice so as to preload the left chambers. On the other hand, a small PFO is left to allow a right to left shunt should pulmonary hypertensive crisis occur early in the postop. Actually, most PFO are already closed on discharge. Thank you again for your comments.

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