The results of the Yasui operation were excellent, showing low mortality and good mid-term left ventricular function without outflow tract stenosis or neoaortic valve insufficiency. Bilateral PAB as initial palliation is a useful option in symptomatic neonates.

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Background Patients with right isomerism have accompanying complex congenital heart disease, which is characterized by pulmonary atresia and total anomalous pulmonary venous return. Balanced regulation of the systemic and pulmonary circulation is essential for successful management, especially for cases complicated with necrotizing enterocolitis (NEC). Case presentation A 6-day-old male neonate with a single ventricle, pulmonary atresia, patent ductus arteriosus (DA), and total anomalous pulmonary venous return associated with right isomerism was admitted because of dyspnea, cyanosis, and melena. The patient presented circulatory incompetence due to excessive pulmonary blood flow, resulting in NEC. The patient underwent DA banding and colectomy following continuous intravenous infusion of prostaglandin E1 at six days. Subsequently, his condition improved, reaching a systemic oxygen saturation of around 80%. He underwent a bidirectional Glenn procedure and closure of colectomy at the ages of 5 and 6 months, respectively. Conclusion DA banding can be an alternative to placing an aortopulmonary shunt, which is conventional in patients with ductus-dependent pulmonary circulation, because DA banding is feasible without cardiopulmonary bypass.

Background The high incidence of postoperative pulmonary venous obstruction (PVO) is a major mortality‐associated concern in patients with right atrial isomerism and extracardiac total anomalous pulmonary venous connection (TAPVC). We evaluated new anatomical risk factors for reducing the space behind the heart after TAPVC repair. Methods Eighteen patients who underwent TAPVC repair between 2014 and 2020 were enrolled. Sutureless technique was used in 12 patients and conventional repair in six patients. The angle between the line perpendicular to the vertebral body and that from the vertebral body to the apex was defined as the “vertebral‐apex angle (V‐A angle).” The ratio of postoperative and preoperative angles, indicating the apex's lateral rotation, was compared between patients with and without PVO. Results The median (interquartile range) age and body weight at repair were 102 (79–176) days and 3.8 (2.6–4.8) kg, respectively. The 1‐year survival rate was 83% (median follow‐up, 29 [11–36] months). PVO occurred in seven patients (39%), who showed an obstruction of one or two branches in the apex side. The postoperative V‐A angle (46° [45°–50°] vs. 36° [29°–38°], p = 0.001) and the ratio of postoperative and preoperative V‐A angles (1.27 [1.24–1.42] vs. 1.03 [0.98–1.07], p = 0.001) were significantly higher in the PVO group than in the non‐PVO group. The cut‐off values of the postoperative V‐A angle and ratio were 41° and 1.17, respectively. Conclusion A postoperative rotation of the heart apex into the ipsilateral thorax was a risk factor for branch PVO after TAPVC repair.