A reappraisal of palliative surgery for total anomalous pulmonary venous connection: description of a new operative technique.

The need for effective palliation of critically ill infants born with total anomalous pulmonary venous connection is reappraised. Careful study of autopsy specimens in patients with this cardiac malformation (patient ages ranging from newborn to 5 1/2 mth) revealed 4 favorable anatomic dispositions in 16 selected hearts: (1) a horizontal vein or a lobar vein larger than 3-mm size was present in every case; (2) these veins were of adequate length for a shunt anastomosis; (3) the heart could be rotated for easy access to the left atrium; and (4) one of the two separate connecting veins in the mixed type could be utilized. Based on morphologic observations and trial procedures on the autopsy specimens, a new palliative operation is proposed which can be performed under normothermia and without cardiopulmonary bypass.