A successful re-operation in emergency for a case of total anomalous pulmonary venous connection
Shiono, N.; Takanashi, Y.; Yoshihara, K.; Matsuura, H.; Matsuo, T.; Sato, H.
Nihon Kyobu Geka Gakkai 37(8): 1537-1542
1989
ISSN/ISBN: 0369-4739 PMID: 2809317 Document Number: 344699
A five-month-old-girl underwent the intra cardiac repair for total anomalous pulmonary venous connection into coronary sinus. The intra-atrial channel from the coronary sinus to the atrial septal defect enlarged with cut-back method was built with the autologous pericardium. About two months after the first operation, she suffered cyanotic attacks associated with bradycardia and respiratory distress. in echocardiogram the channel from the coronary sinus to the left atrium showed severe stenosis. The pulmonary artery pressure elevated over systemic arterial pressure in cardiac catheterization. When she was referred and transferred to our hospital, 4 months after the first operation, her condition deteriorated and required reoperation in emergency for shock. In the second operation, under cardiopulmonary bypass, the channel from the coronary sinus to the left atrium became stenotic like pinhole with heavy thickening of autologous pericardium and atrial septum. Then, autologous pericardium was detached and cut-back of the atrial septum was added widely. New channel was established with the preserved equine pericardium. Although respiratory care extended for respiratory distress, post-operative course was satisfied. We considered that hemodynamic load seemed mainly to contribute to the thickening of the autologous pericardium, but the effect produced with the growth could not be negated. The meticulous follow-up should be recommended.