The Surgical Therapy of Extracardiac Anomalous Pulmonary Drainage

Abstract

The English surgical literature was reviewed for a 10-year period between 1950 and 1960. A total of 166 patients with anomalous pulmonary venous drainage treated surgically was found. Of this number, 65 patients had total anomalous pulmonary venous drainage (40 per cent). Ninety-five patients (57 per cent) had anomalous venous drainage via extracardiac channels. The over-all survival rate for 166 patients was 74 per cent. The single lesion with the lowest survival rate (35 per cent) was total anomalous pulmonary venous drainage via a persistent left anterior cardinal vein. Of the 34 patients in this category, only three (9 per cent) had a complete repair of the anomalous drainage with survival. A series of 10 patients with anomalous venous drainage via extracardiac channels operated on with the aid of extracorporeal circulation is reported. There were three deaths. Drainage occurred via the superior vena cava (six patients), the coronary sinus (two patients), and a persistent left anterior cardinal vein (two patients). Included in the series is a fourth instance of successful complete repair of total anomalous pulmonary venous drainage via a persistent left anterior cardinal vein. The clinical features, methods of repair, and perfusion data are reviewed. An important aspect of treatment for total anomalous pulmonary venous drainage is the realization that impedance of pulmonary venous outflow is extremely hazardous. It is suggested that pulmonary venous pressure be monitored when complete repair is contemplated. If complete occlusion of decompressive channels causes a significant increase in the pulmonary venous pressure, some avenue of decompression should be left; otherwise, venous infarction of the lungs with probable fatality will result.