Intra-atrial rerouting by the posterior left atrial wall flap for total anomalous pulmonary venous return drainage into the coronary sinus in neonates

Article Outline

• Case 1
• Case 2
• References
• Copyright

CTSNet classification: 20

To the Editor:

We read with great interest the new procedure for total anomalous pulmonary venous return (TAPVR) drainage into the coronary sinus (CS), which Yamagishi and colleagues¹ successfully performed for an infant weighing 5.5kg. Briefly, the roof of the CS was incised toward the left atrium (LA) to create a flap from the posterior wall of the LA (=the anterior wall of the common chamber and the CS). The flap thus created was then moved anteriorly to cover the entire atrial communication and the CS orifice. However, we were unable to find any follow-up reports on this procedure. We recently successfully performed this procedure for 2 neonatal cases and recognized several important features associated with this surgery.

Back to Article Outline

Case 1 

A baby girl with a birth weight of 2.7kg underwent this new procedure for TAPVR drainage into the CS at 8 days of age. She was discharged on postoperative day 22 without any complications. Postoperative echocardiogram demonstrated a large communication between the LA and the common chamber (Figure 1, A). An abnormal continuous flow was detected at the superior wall of the CS. This flow was directed toward the common chamber and appeared to be a small coronary arterial flow (Figure 1, B). This abnormal flow disappeared 2 months after the operation. One year after the operation, the patient was doing well with no evidence of arrhythmia.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 1 

  A, Echocardiogram after surgery. Parasternal long-axis view during the diastolic phase showing a large communication between the LA and the common chamber. B, Another parasternal long-axis view showing an abnormal continuous flow from the posterior wall of the new LA toward the common chamber. RV, Right ventricle; LV, left ventricle; Ao, aorta; LA, left atrium; CC, common chamber.

Back to Article Outline

Case 2 

The new procedure was also performed on a 20-day-old baby girl (birth weight, 3.0kg) who had TAPVR drainage into the CS. Because the posterior wall flap of the LA was not sufficiently large to cover the entire atrial septal defect and CS orifice, a fresh autologous pericardial patch was applied to close the rest of the atrial communication. At 1 year and 7 months after the operation, she is in good clinical status with no arrhythmia.

The usual surgical treatment for TAPVC to the CS is either the CS cut-back procedure or the Van Praagh technique.² The advantages of this new procedure compared with these previously performed procedures are as follows:

However, the following cautionary points should be noted:

We believe that this new procedure is applicable even in neonatal cases with TAPVC drainage into the CS. However, a long observation period will be required for those patients who undergo this new procedure.

Back to Article Outline

References 

1. Yamagishi M, Shuntoh K, Takahashi A, Shinkawa T, Miyazaki T, Kitamura N. Intra-atrial rerouting by transference of the posterior left atrial wall for cardiac-type total anomalous pulmonary venous return. J Thorac Cardiovasc Surg. 2002;123:996–999
   • View In Article
   • Abstract
   • Full Text
   • Full-Text PDF (1358 KB)
   • CrossRef
2. Van Praagh R, Harken AH, Delisle G, Ando M, Gross RE. Total anomalous pulmonary venous drainage to the coronary sinus: a revised procedure for its correction. J Thorac Cardiovasc Surg. 1972;64:132–135
   • View In Article
   • MEDLINE