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Chirurgia 2013 April;26(2):167-9

language: English

How to manage small left atrium in repair for total anomalous pulmonary venous connection in adult

Wang H. B. 1, Zhang W. 2, Zhao Y. W. 3

1 Department of Cardiac-Thoracic Surgery, Sixth People’s Hospital in Southern Branch, Shanghai Jiaotong University, Fengxian District Central Hospital, Shanghai, China;
2 Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China;
3 Department of Ultrasound, Sixth People’s Hospital in Southern Branch, Shanghai Jiaotong University, Fengxian District Central Hospital, Shanghai, China


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A 22-year-old male patient was admitted with supracardiac, nonobstructive, total anomalous pulmonary venous connection and large atrial septal defect. Complete repair was performed through median sternotomy and cardiopulmonary bypass. The intra-atrial approach was taken to connect pulmonary venous confluence and left atrium. The small left atrium was enlarged with a patch, forming the cap shape bulge to the right atrium, increased 30% area in transthoracic echocardiography view with good result. The patient was discharged from hospital on the ninth postoperative day. The left atrium size and pulmonary artery pressure changed to normal quickly in 3 months. At three-month follow-up he is currently asymptomatic, with normal cardiac morphology and no echocardiographic signs of pulmonary hypertension. Large enough and without kinking or twisting of the anastomosis and enough left atrium volume are the key to reduce pulmonary vascular resistance intra or postoperative.

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