*****ANNALS OF THORACIC SURGERY*****

(REFERENCE 1 OF 13)
99347500

Choudhary SK  Bhan A  Sharma R  Mathur A  Airan B  Saxena A  Kothari SS  
  Juneja R  Venugopal P  
Repair of total anomalous pulmonary venous connection in infancy:
  experience from a developing country.

In: Ann Thorac Surg (1999 Jul) 68(1):155-9

ISSN: 0003-4975

BACKGROUND: Corrective surgery for total anomalous pulmonary venous
  connection in infancy still carries high morbidity and mortality
  rates in developing countries. The present study evaluates the
  factors responsible for it. METHODS: Seventy-three infants were
  operated on for total anomalous pulmonary venous connection from
  January 1987 through October 1997. Age ranged from 5 days to 12
  months (mean, 3.9+/-0.24 months), with 10 (13.7%) patients younger
  than 1 month old. Patient weight varied from 2.0 to 5.2 kg (mean,
  3.7+/-0.27 kg). Most (90.5%) patients were small for their ages (<
  50th percentile). Anomalous connection was supracardiac in 42
  (57.5%), cardiac in 18 (24.7%), infracardiac in 4 (5.5%), and mixed
  in 9 (12.3%) patients. Thirty-five patients had obstructed drainage.
  Preoperatively, 30 patients received antibiotic therapy for
  respiratory tract infection, 3 patients had balloon atrial
  septostomy, and 4 patients required mechanical ventilation. Fifteen
  patients (20.5%) were operated on as an emergency procedure. For
  supracardiac and infracardiac connections, a posterior approach was
  used for anastomosis. In cardiac type, coronary sinus was unroofed
  and the resultant defect along with atrial septal defect was closed
  with a single patch. RESULTS: The operative mortality rate was 23.3%
  (17 of 73). Pulmonary hypertensive crisis was the cause of death in
  10 patients. Emergency operation and weight less than the 25th
  percentile were the important risk factors for operative mortality.
  Young age (< 1 month) and type of drainage did not affect the
  mortality. Follow-up ranged from 1 to 108 months (mean, 56.4+/-26.0
  months). There were two late deaths. The actuarial survival (Kaplan
  Meier) at 9 years was 72.87%+/-5.39%. CONCLUSION: Failure of early
  recognition, and thus delayed referral, accounted for onset of
  cardiac cachexia, respiratory tract infection, and severe pulmonary
  hypertension, which had a major effect on unfavorable outcome.

Institutional address: 
     Department of Cardiothoracic and Vascular Surgery
     Cardiothoracic Center
     All India Institute of Medical Sciences
     New Delhi.

(REFERENCE 2 OF 13)
99090949

Caldarone CA  Najm HK  Kadletz M  Smallhorn JF  Freedom RM  Williams WG  
  Coles JG  
Surgical management of total anomalous pulmonary venous drainage:
  impact of coexisting cardiac anomalies.

In: Ann Thorac Surg (1998 Nov) 66(5):1521-6

ISSN: 0003-4975

BACKGROUND: Recent reports have cited improving results for surgical
  management of isolated total anomalous pulmonary venous drainage.
  Complex cases (with other cardiac anomalies) are less frequently
  reported and are associated with higher mortality. METHODS:
  Retrospective review identified 170 consecutive patients treated for
  total anomalous pulmonary venous drainage from 1982 to 1996: 44 cases
  were "complex" (with significant associated cardiac lesions) and 126
  cases were "simple." RESULTS: Operative mortality for simple cases
  decreased from 26% to 8%, and mortality for complex cases remained
  constant at 52%. Age, size, and the presence of atrial isomerism were
  univariate predictors of mortality. Multivariable analysis identified
  only univentricular hearts and associated cardiac lesions as
  predictors of operative mortality. Pulmonary artery (n = 16) and
  arteriopulmonary (n = 7) shunting strategies for complex cases
  resulted in less than 30% long-term survival. CONCLUSIONS: Despite
  improvement in survival for simple cases, management of total
  anomalous pulmonary venous drainage with single-ventricle hearts or
  other associated cardiac lesions remains problematic.

Institutional address: 
     Division of Cardiovascular Surgery
     The Hospital for Sick Children
     University of Toronto and University of Toronto Faculty of Medicine
     Ontario
     Canada. Chris-Caldarone@UIowa.edu

(REFERENCE 3 OF 13)
99090948

Caldarone CA  Najm HK  Kadletz M  Smallhorn JF  Freedom RM  Williams WG  
  Coles JG  
Relentless pulmonary vein stenosis after repair of total anomalous
  pulmonary venous drainage.

In: Ann Thorac Surg (1998 Nov) 66(5):1514-20

ISSN: 0003-4975

BACKGROUND: Progressive stenosis of the pulmonary veins after repair
  of total anomalous pulmonary venous drainage is frequently refractory
  to surgical therapy. METHODS: Retrospective review of 170 consecutive
  patients treated for total anomalous pulmonary venous drainage
  identified 13 patients with postrepair pulmonary vein stenosis.
  Preoperative and operative data were analyzed to define the patterns
  of progression and efficacy of surgical techniques. RESULTS:
  Seventeen reoperations were performed in 13 patients. Postrepair
  pulmonary vein stenosis was most common in the infracardiac and mixed
  subtypes (p < 0.02). All 4 patients with unilateral stenosis, 2 of
  whom had progression of stenosis resulting in nearly complete
  unilateral pulmonary vein occlusion, survived. Six of 9 patients with
  bilateral disease died (p < 0.05 versus unilateral); 2 of the 3
  survivors were repaired with a novel technique creating a sutureless
  neoatrium without evidence of restenosis at 1.8 years' follow-up.
  Stenting was uniformly unsuccessful. CONCLUSIONS: In unilateral
  stenosis, progression of disease may be survivable with loss of
  single-lung perfusion. Although bilateral disease is lethal in most
  cases, creation of a sutureless neoatrium has demonstrated short-term
  freedom from disease progression.

Institutional address: 
     Division of Cardiovascular Surgery
     The Hospital for Sick Children
     University of Toronto and University of Toronto Faculty of Medicine
     Canada. Chris-Caldarone@UIowa.edu

(REFERENCE 4 OF 13)
99015458

Imoto Y  Kado H  Asou T  Shiokawa Y  Tominaga R  Yasui H  
Mixed type of total anomalous pulmonary venous connection.

In: Ann Thorac Surg (1998 Oct) 66(4):1394-7

ISSN: 0003-4975

BACKGROUND: The mixed type of total anomalous pulmonary venous
  connection is a rare condition in which some diagnostic and surgical
  problems still remain to be solved. METHODS: In 9 patients a single
  pulmonary vein was connected to the systemic vein at a site different
  from the drainage site of the confluence of three other pulmonary
  veins. In 2 other patients, four pulmonary veins made a confluence
  which had two drainage sites. Correct diagnosis was made in all 7
  patients who received cardiac catheterization but only in 5 of the 9
  patients by color Doppler echocardiography. Total correction was
  performed in 3 patients and the single anomalous pulmonary vein was
  left uncorrected in 8 other patients. RESULTS: There were two in-
  hospital deaths. Seven patients with a single residual anomalous
  pulmonary vein have been in good condition without clinical symptoms
  of congestive heart failure or pulmonary hypertension. CONCLUSIONS:
  Diagnosis of mixed type of total anomalous pulmonary venous
  correction by echocardiography is sometimes difficult. When a mixed
  type is suspected, cardiac catheterization is recommended if the
  condition of the patient permits it. A single anomalous pulmonary
  vein may be left uncorrected without serious complications, but close
  observation is needed to prevent congestive heart failure and
  pulmonary vascular obstructive disease.

Institutional address: 
     Department of Cardiovascular Surgery
     Fukuoka Children's Hospital
     Kyushu University
     Japan.

(REFERENCE 5 OF 13)
95289768

Gaynor JW  Burch M  Dollery C  Sullivan ID  Deanfield JE  Elliott MJ  
Repair of anomalous pulmonary venous connection to the superior vena
  cava.

In: Ann Thorac Surg (1995 Jun) 59(6):1471-5

ISSN: 0003-4975

Complex forms of anomalous pulmonary venous connection to the
  superior vena cava (SVC) can be difficult to correct surgically.
  Since 1987, 11 patients have undergone repair of anomalous pulmonary
  venous connection to the SVC by diversion of the pulmonary venous
  drainage to the left atrium using a baffle with division of the SVC
  and reimplantation on the right atrial appendage to restore normal
  systemic venous drainage. Total anomalous pulmonary venous connection
  was present in 3 patients and partial anomalous pulmonary venous
  connection, in 8. All patients are alive and asymptomatic at a mean
  follow-up of 2.3 +/- 1.4 years. Postoperative echo-cardiograms (8
  patients) revealed pulmonary venous obstruction requiring reoperation
  in 1 patient. No patient has clinical evidence of SVC obstruction,
  and all are in sinus rhythm. This is a safe and effective technique
  for repair of complex forms of anomalous pulmonary venous connection
  to the SVC, and the incidence of postoperative venous obstruction and
  rhythm disturbances is low.

Institutional address: 
     Cardiothoracic Unit
     Hospital for Sick Children
     London
     England.

(REFERENCE 6 OF 13)
98391270

McElhinney DB  Reddy VM  
Anomalous pulmonary venous return in the staged palliation of
  functional univentricular heart defects.

In: Ann Thorac Surg (1998 Aug) 66(2):683-7

ISSN: 0003-4975

BACKGROUND: Bidirectional cavopulmonary shunt and Fontan repair are
  now commonly performed in patients with a variety of forms of complex
  single ventricle, including those with anomalies of systemic,
  pulmonary, or systemic and pulmonary venous return. These anomalies
  are ideally dealt with during bidirectional cavopulmonary shunt,
  thereby minimizing the complexity of the eventual Fontan procedure.
  METHODS AND RESULTS: Between March 1990 and March 1997, 32 patients
  with functional single ventricle and anomalous pulmonary venous
  return underwent operation at our institution. Five of 25 patients
  who underwent neonatal palliation died in the early postoperative
  period, all of whom had obstructed anomalous pulmonary venous return.
  Twenty-one patients have undergone bidirectional cavopulmonary shunt,
  including 7 in whom this was the primary palliative procedure. There
  was one early and two late deaths after the bidirectional Glenn
  procedure, two in patients with asplenia syndrome and none in
  patients with previously obstructed pulmonary venous return. Seven
  patients have undergone Fontan completion, 5 with an extracardiac
  conduit. There was one early death and one take-down to a classic
  Glenn shunt, both in patients who did not undergo the extracardiac
  conduit Fontan operation. CONCLUSIONS: Anomalous pulmonary venous
  return can significantly complicate the management of the single-
  ventricle patient, with the major impact on survival coming in the
  neonatal period. Palliation with the aim of performing an
  extracardiac conduit Fontan procedure allows greater latitude and
  more streamlined management in this group of patients.

Institutional address: 
     Division of Cardiothoracic Surgery
     University of California
     San Francisco 94143-0118
     USA.

(REFERENCE 7 OF 13)
98257228

Serraf A  Belli E  Roux D  Sousa-Uva M  Lacour-Gayet F  Planche C  
Modified superior approach for repair of supracardiac and mixed total
  anomalous pulmonary venous drainage.

In: Ann Thorac Surg (1998 May) 65(5):1391-3

ISSN: 0003-4975

BACKGROUND: The main goal in the surgical repair of total anomalous
  pulmonary venous drainage is to reestablish a wide patent connection
  between the common pulmonary vein and the left atrium. Several
  techniques have been proposed for achieving this objective, each of
  which has advantages and disadvantages. The superior approach between
  the superior vena cava and the ascending aorta was introduced in 1976
  for the repair of supracardiac forms of total anomalous pulmonary
  venous drainage, but it often provides a less than optimum exposure,
  particularly in tiny infants. We proposed a modification of this
  approach that includes division of the ascending aorta and offers
  excellent exposure. METHODS: Seventeen patients (15 neonates and 2
  infants) with supracardiac total anomalous pulmonary venous drainage
  (n = 13) or mixed forms of total anomalous pulmonary venous drainage
  (n = 4) underwent surgical repair with the use of the modified
  superior approach. Circulatory arrest was not required in 10 patients
  and the mean cross-clamp time was 32.5 +/- 13.8 minutes. RESULTS:
  There was 1 postoperative death resulting from intractable pulmonary
  hypertension in a compromised infant who was referred to our unit
  receiving extracorporeal membrane oxygenation. One patient with
  common hypoplasia underwent reoperation twice at 2 months and then 3
  months after the first procedure. All the other patients had a smooth
  postoperative course, and midterm evaluation showed a widely patent
  anastomosis between the common vein and the left atrium. CONCLUSIONS:
  The modified superior approach for the repair of supracardiac total
  anomalous pulmonary venous drainage can be useful to enhance exposure
  during surgical repair and may contribute to improved patient
  outcome.

Institutional address: 
     Department of Pediatric Cardiac Surgery
     Marie-Lannelongue Hospital
     Le Plessis-Robinson
     France. aserraf@centre-chirurgical-marie-lannelongue.asso.fr

(REFERENCE 8 OF 13)
94107074

Heinemann MK  Hanley FL  Van Praagh S  Fenton KN  Jonas RA  Mayer JE Jr  
  Castaneda AR  
Total anomalous pulmonary venous drainage in newborns with visceral
  heterotaxy.

In: Ann Thorac Surg (1994 Jan) 57(1):88-91

ISSN: 0003-4975

Children with visceral heterotaxy often present with total anomalous
  pulmonary venous drainage (TAPVD) associated with univentricular
  congenital heart disease. We reviewed our experience with the primary
  surgical management of this lesion under these circumstances. Over a
  recent 10-year span, 38 patients within the first 3 days of life were
  admitted to our institution and underwent primary palliation. Twenty-
  one of them had TAPVD, 18 to a systemic vein. Twelve (67%) of these
  18 were seen with obstruction of the anomalous connection and
  underwent emergency operation. In 7 patients, repair of TAPVD was
  combined with a systemic-pulmonary artery shunt because of additional
  obstruction of the pulmonary blood supply, with two deaths. One
  patient had primary shunting and then repair of TAPVD. Four patients
  underwent repair of TAPVD alone. Two of them then showed signs of
  insufficient pulmonary blood flow, received a shunt in a second
  procedure, and subsequently died. Early mortality in the group with
  obstructed TAPVD was thus 4 (33%) of 12 patients. Statistical
  analysis of all 38 patients (univariate analysis, chi 2 testing)
  showed that neither the presence of TAPVD (p = 0.7) nor TAPVD repair
  alone (p = 0.8) or with shunting (p = 0.8) was a definite risk factor
  for early death. The performance of a shunt during the first
  operation, however, was associated with lower early mortality (p =
  0.03). Total anomalous pulmonary venous drainage is a common finding
  in newborns with visceral heterotaxy. Its presence and its subsequent
  early repair (requiring cardiopulmonary bypass) do not increase the
  mortality risk. The need of a concomitant shunt in obstructed TAPVD
  can initially be underestimated.

Institutional address: 
     Department of Cardiac Surgery
     Children's Hospital
     Harvard Medical School
     Boston
     Massachusetts.

(REFERENCE 9 OF 13)
93111822

Cobanoglu A  Menashe VD  
Total anomalous pulmonary venous connection in neonates and young
  infants: repair in the current era [see comments]

In: Ann Thorac Surg (1993 Jan) 55(1):43-8; discussion 48-9

ISSN: 0003-4975

Total anomalous pulmonary venous connection has been one of the more
  challenging congenital heart defects in newborns and young infants
  despite improvements in surgical technique, cardiac anesthesia,
  neonatal myocardial preservation, and postoperative care. Since 1981,
  30 patients with total anomalous pulmonary venous connection have
  undergone primary total correction. Mean age at operation was 28 +/-
  6 days and mean weight, 3.3 +/- 0.7 kg. Essential features of the
  surgical approach in these small patients included early surgical
  intervention, profound hypothermia with total circulatory arrest,
  cardioplegic myocardial preservation, and a wide posterior
  anastomosis. Operative mortality was 13% +/- 6%. All four deaths were
  in patients having emergency operation within 24 hours of the
  surgical consult and requiring ventilator support preoperatively. The
  mean follow-up is 47 +/- 7 months. There have been two late deaths,
  and the 7-year survival rate is 79% +/- 8%. There have been two
  reoperations, and 91% +/- 6% of the patients are reoperation free at
  7 years. Only 1 of the 24 surviving patients is symptomatic. Growth
  in survivors is closely monitored. The height growth percentile is
  less than 5% in 15% +/- 8% of survivors and the weight growth
  percentile, less than 5% in 17 +/- 8%. During the past decade, with a
  consistent surgical approach to neonates and infants with total
  anomalous pulmonary venous connection, it has been possible to
  achieve low early mortality, low attrition, and excellent late
  results.

Comment in: Ann Thorac Surg 1993 Aug;56(2):395

Institutional address: 
     Division of Cardiopulmonary Surgery
 
     Oregon Health Sciences University
     Portland 97201-3098.


*****CIRCULATION*****

(REFERENCE 10 OF 13)
97057373

Bando K  Turrentine MW  Ensing GJ  Sun K  Sharp TG  Sekine Y  Girod DA  
  Brown JW  
Surgical management of total anomalous pulmonary venous connection.
  Thirty-year trends.

In: Circulation (1996 Nov 1) 94(9 Suppl):II12-6

ISSN: 0009-7322

BACKGROUND: Reports of surgical correction of total anomalous
  pulmonary venous connection (TAPVC) over the past 30 years indicate a
  general improvement in operative survival. However, prevention of
  late pulmonary venous obstruction continues to be a cornerstone of
  successful repair. The purpose of the study was to identify factors
  associated with improvement in perioperative mortality and to
  determine risk factors for death and reoperation due to pulmonary
  vein stenosis after repair of TAPVC. METHODS AND RESULTS: Using
  univariate and multiple regression analysis, we analyzed risk of
  early and late mortality and need for reoperation in 105 patients
  operated on between April 1966 and June 1995. Despite increased
  frequency of neonatal repair in the most recent time period (29% in
  1966 through 1985; 55% in 1991 through 1995, P < .05), operative
  mortality declined (13% in 1966 through 1985; 0% in 1991 through
  1995). The incidence of postoperative pulmonary hypertensive episodes
  and death related to pulmonary hypertension decreased significantly
  over the study period (P < .001). Aggressive preoperative elective
  medical stabilization and prophylaxis of postoperative pulmonary
  hypertensive episodes may have contributed to this improvement. By
  univariate analysis, preoperative pulmonary hypertension (P < .02)
  and preoperative pulmonary vein obstruction (P < .01) correlated with
  early mortality up to 1990 but not in the past 5 years. Multiple
  logistic regression analysis showed that only a small pulmonary
  confluence associated with diffuse pulmonary vein stenosis was an
  independent risk factor for early (P < .001) and late (P = .01) death
  as well as need for reoperation (P = .007). Type of TAPVC was not a
  significant risk factor throughout the three decades of our
  experience. At a median follow-up of 87 months, late survival was 98%
  (93 of 95 operative survivors), and all are NYHA class I.
  CONCLUSIONS: Improvements on surgical technique as well as
  preoperative and postoperative management account for the reduction
  in mortality and need for reoperation for most types of TAPVC.
  However, the presence of a small venous confluence and diffuse
  pulmonary vein stenosis remains a risk factor for adverse outcome.

Institutional address: 
     Section of Cardiothoracic Surgery
     James W. Riley Hospital for Children
     Indianapolis
     IN
     USA.


*****JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY*****

(REFERENCE 11 OF 13)
92356635

Raisher BD  Grant JW  Martin TC  Strauss AW  Spray TL  
Complete repair of total anomalous pulmonary venous connection in
  infancy.

In: J Thorac Cardiovasc Surg (1992 Aug) 104(2):443-8

ISSN: 0022-5223

From 1983 to 1990, 20 infants underwent complete repair of isolated
  total anomalous pulmonary venous connection. Twelve were male; ages
  ranged from 1 day to 240 days (mean 32 days). The abnormal anatomic
  connection was supracardiac in nine, cardiac in four, mixed in five,
  and infradiaphragmatic in two. In seven patients the pulmonary venous
  drainage was obstructed. Corrective operations were performed 2.4
  days after admission; after medical stabilization, seven patients
  underwent emergency operations, including extracorporeal membrane
  oxygenation in one. All operations were performed with the use of
  circulatory arrest (mean 33 minutes) and cardiopulmonary bypass (mean
  54 minutes). There was one hospital death, which occurred in a
  premature infant (1.5 kg) who had supracardiac drainage. No
  preoperative risk factors correlated with a poor surgical outcome.
  Pulmonary hypertensive episodes were expectantly managed after the
  operation with 100% oxygen, sedation, and hyperventilation.
  Postoperative arrhythmias occurred predominantly in patients with
  intracardiac drainage. All survivors (mean follow-up of 42 months)
  are in sinus rhythm, receiving no medications, and are growing and
  developing normally. Surgical correction of total anomalous pulmonary
  venous connection in infancy can be performed at low risk with good
  results after aggressive preoperative stabilization and postoperative
  management.

Institutional address: 
     Division of Cardiology
     St. Louis Children's Hospital
     Mo.

(REFERENCE 12 OF 13)
99197171

Lacour-Gayet F  Zoghbi J  Serraf AE  Belli E  Piot D  Rey C  Marcon F  
  Bruniaux J  Planche C  
Surgical management of progressive pulmonary venous obstruction after
  repair of total anomalous pulmonary venous connection.

In: J Thorac Cardiovasc Surg (1999 Apr) 117(4):679-87

ISSN: 0022-5223

BACKGROUND: The occurrence of a progressive pulmonary venous
  obstruction after the repair of the total anomalous pulmonary venous
  connection is a severe complication. OBJECTIVES: The objectives of
  this study were to retrospectively review the patients with this
  condition and to report our experience with a new surgical technique
  with a sutureless in situ pericardium repair. METHODS: Of 178
  patients who underwent correction of total anomalous pulmonary venous
  connection, 16 patients (9%) experienced the development of a
  progressive pulmonary venous obstruction in a median interval of 4
  months (5 weeks-12 years). Three patients had isolated anastomotic
  stenosis, 4 patients had isolated pulmonary venous ostial stenosis,
  and 9 patients had both. Pulmonary venous obstruction was bilateral
  in 7 patients. The surgical procedures used at reoperation included 8
  patch enlargements, 5 ostial endarterectomies, 1 intraoperative
  stenting, and 7 sutureless in situ pericardium repairs. RESULTS:
  There were 4 deaths after reoperation (4 of 15 patients; 27%). The
  only significant mortality risk factor was the bilateral location of
  the pulmonary venous obstruction (P =.045). In patients with isolated
  anastomotic stenosis or with only 1 pulmonary venous ostial stenosis
  (n = 5), there was no death, except the patient presenting with a
  single ventricle. In patients with 2 or more pulmonary venous ostial
 
  stenoses (n = 10), there were 3 deaths; 5 of the 7 survivors were
  successfully treated with the in situ pericardial technique, with
  normalized pulmonary artery pressure at a mean follow-up of 26
  months. CONCLUSION: Progressive pulmonary venous stenosis after
  repair of total anomalous pulmonary venous connection remains a
  severe complication when bilateral. The sutureless in situ
  pericardial repair offers a satisfactory solution, particularly on
  the right side.

Institutional address: 
     Marie-Lannelongue Hospital
     Paris-Sud University
     Paris
     France.

(REFERENCE 13 OF 13)
94048176

Lupinetti FM  Kulik TJ  Beekman RH 3d  Crowley DC  Bove EL  
Correction of total anomalous pulmonary venous connection in infancy.

In: J Thorac Cardiovasc Surg (1993 Nov) 106(5):880-5

ISSN: 0022-5223

From January 1985 through January 1993, 41 patients less than 1 year
  of age underwent operative correction of isolated total anomalous
  pulmonary venous connection. There were 24 boys and 17 girls. The
  median age at operation was 13 days (range 1 to 282 days) and weight
  was 3.6 kg (2.5 to 5.2 kg). Locations of the connections were
  supracardiac in 19, cardiac in 9, infracardiac in 11, and mixed
  supracardiac and cardiac in 2. Obstruction of the pulmonary veins was
  severe in 24, mild in 3, and absent in 14. Preoperative stabilization
  included mechanical ventilation for 15 patients for a mean duration
  of 2 1/2 days and extracorporeal membrane oxygenation for 1 patient
  for 1 day. All operations were performed with deep hypothermia and
  circulatory arrest (mean arrest time 34 minutes). Supracardiac
  connections were repaired by performing a side-to-side anastomosis
  between the pulmonary venous confluence and the dome of the left
  atrium through a superior approach between the superior vena cava and
  the aorta. Coronary sinus connections were repaired by enlarging the
  atrial septal defect and the coronary sinus communication with the
  left atrium and closing the atrial defect with a large patch.
  Infracardiac repairs included elevation and rotation of the heart to
  the right and an elongated side-to-side anastomosis between the
  common venous confluence and the left atrium. One patient died 1 week
  postoperatively of persistent pulmonary hypertension. Another
  patient, who was supported by extracorporeal membrane oxygenation
  before the operation, died 3 months after the operation as a
  consequence of pulmonary lymphangiectasia. All other patients are
  alive and well with a mean follow-up of 26 months (range 3 to 77
  months). One patient required two subsequent reoperations for
  persistent pulmonary venous obstruction, and another patient had
  superior vena cava obstruction necessitating reoperation. Operative
  treatment of total anomalous pulmonary venous connection in infants
  can be performed with low mortality and an infrequent need for
  reoperations.

Institutional address: 
     Department of Surgery
     University of Michigan School of Medicine
     Ann Arbor.