The Early and Late Results of Postoperative Period in Total Anomalous Pulmonary Venous Return

We reviewed retrospectively 37 patients with total anomalous pulmonary venous return between August 1976 and October 1995 in Hacettepe University Medical Faculty and Institute of Cardiology, University of Istanbul. Their ages were ranging from 9 days to 20 years (mean: 33.4 months) and 22 of them were younger than one year old. Supracardiac type of anomaly in 16 patients, cardiac type in 15, infracardiac type in 3 and mixed types in 3 were detected. Pulmonary hypertension in 16 patients and pulmonary congestion in 14 patients were predominant preoperatively. Some additional cardiac pathologies were determined in 9 patients. Five severely ill patients in neonatal period because of heart failure and pulmonary congestion were intubated preoperatively and underwent emergency operation. Total circulatory arrest under deep hypothermia was used in all neonates and infants and also in patients with infracardiac type anomaly. In older children, a short period of low-flow cardiopulmonary bypass under moderate hypothermia was preferred. The anastomosis between the common pulmonary venous chamber and the left atrium was constructed by transatrially in 7 patients with supracardiacc type of anomaly and by posterior approach in the rest of patients. Three patients (8.1%) were lost in the postoperative early period and 2 patients in the late follow up. We determined anastomotic restenosis in a patient (2.9 %) two years after the operation. Rest of patients (97.3%) were followed up between 2 and 231 months (mean: 5 years). These patients were asymptomatic with a normal growth. As a result we can say that persistent pulmonary hypertension and pulmonary venous obstruction were the main risk factors on postoperative morbidity and mortality. The patients with additional cardiac pathologies and who need preoperative intubation carry a high risk in our series.