Surgical Treatment of Partial Anomalous Pulmonary Venous Drainage

Abstract

Fourteen children who had been operated on for partial anomalous pulmonary venous return from the right lung to the vena cava or right atrium have been submitted to a follow-up study 1 to 9 years after surgery. This included clinical, hemodynamic, and angiographic data. All patients were doing well and had normal exercise tolerance at the time of follow-up examination. Electrocardiograms and chest roentgenograms had returned to normal in 10 and were improved in three. Hemodynamic and angiographic data demonstrated perfect correction in eight. Of the remaining six, three had an obstructed superior vena cava (SVC) with collateral pathways to a persistent left superior vena cava in two and to the inferior vena cava in one. Three had significant pressure gradients between the SVC and the right atrium, two with a small right-to-left shunt from the SVC to the left atrium, and one with an additional small left-to-right shunt. None had obstruction to the pulmonary venous return. These complications occurred exclusively in cases in which at least one anomalous vein drained high into the superior vena cava. Enlargement of the SVC with a patch of pericardium gave good results in three patients with this type of anomalous drainage but did not prevent obstruction or severe narrowing of the SVC in two other cases. It is concluded that the present corrective technics are not adequate for cases in which an anomalous vein drains high in the SVC, especially in the presence of a left superior vena cava.