No abstract

From May 1995 through October 2001, 19 infants less than 90 days old underwent surgical correction of total anomalous pulmonary venous connection. In 15 babies with isolated total anomalous pulmonary venous connection, there was one operative death. In 4 with complex anomalies, there were 2 operative deaths. The vertical vein was not ligated in 6 cases for various reasons. Two patients died during reoperation for early pulmonary venous obstruction. In the late follow-up, 2 babies required reoperation for late anastomotic stricture; one needed additional balloon dilatation. Of the 14 surviving patients, one had a small residual gradient and infrequent supraventricular tachycardia, the others were asymptomatic and without gradients. Surgical correction of total anomalous pulmonary venous connection can be carried out in early infancy with low mortality and morbidity. However, associated complex cardiac anomalies and small caliber pulmonary arteries and veins carry higher risks. Recurrent pulmonary venous obstruction and diffuse pulmonary vein stenosis are causes of early reoperation and poor surgical outcome.

The technique of direct transfer of an anomalous left coronary artery from the pulmonary artery to the aorta was modified. Using part of the lateral and anterior wall of the pulmonary artery as a flap in continuity with the coronary button as part of the transfer, a tension-free anastomosis is possible. This technique was employed in 3 consecutive infants, with good outcome.

A 30-year-old man with Human Immunodeficiency Virus (HIV) in Advanced Immuno Deficiency Syndrome (AIDS) presented with acute type 1 aortic dissection in a state of shock. He underwent emergency surgical repair with placement of a 28 mm woven Dacron interposition graft. Cluster Differential (CD4) counts at admission were 23cells/μl. The decision to operate this patient was difficult as the risk of mortality and morbidity following surgery is high, because of the increased risk of opportunistic infections, in patients with CD4 counts less than 50 cells/μl. The data related to early outcome following such complex surgeries in this subset of patients is not available. (Ind J Thorac Cardiovasc Surg 2009; 25: 127-129)