Figure 10 : MAXIMUM INTENSITY PROJECTION CORONAL VIEW – IN P 10

VERTICAL VEIN (BLUE ARROW) (PAPVD FROM LEFT UPPER LOBE OF LUNG) DRAINING INTO LEFT BRACHIOCEPHALIC VEIN (RED ARROW HEAD)

RIGHT BRACHIOCEPHALIC VEIN (BLUE ARROW HEAD)

AA: ARCH OF AORTA, SVC: SUPERIOR VENA CAVA, PA PULMONARY ARTERY, RA: RIGHT ATRIUM, LA LEFT ATRIUM, LV: LEFT VENTRICLE, IVC: INFERIOR VENA CAVA

(Image Credits, Figure 9 – 10 : Dr.Viral B. Patel)

Surgical techniques

All procedures were performed through a median sternotomy. Cardiopulmonary bypass was used with bicaval cannulation in 7 patients and tricaval cannulation in 3 and with ascending aortic cannulation at moderate systemic hypothermia (25oC-32oC) in all patients.

We achieved cardioplegic arrest with Del Nido cardioplegia and topical slush saline. We did not routinely use a left ventricular vent. All patches were made from fresh autologous pericardium. In 2 patients (20%), we performed single-patch/sandwich-patch repair of the SVASD with inclusion of the PAPVC and ASD closure; in 7 (70%), we performed repair with two pericardial patches to enlarge the SVC-RA junction (Figures 11 to 12).

Stenosis of the SVC and the right-sided pulmonary veins was graded as trivial, mild, moderate, or severe. Preoperative and postoperative electrocardiography (ECG) was performed in all 10 patients. Initial postoperative ECG was considered early, and ECG after hospital discharge was considered late.