Total anomalous pulmonary venous connection.

Repair of total anomalous pulmonary venous connection was performed on 31 patients aged 12 days to 14 years (18 less than 6 months). The connection type was supracardiac in 20 cases, cardiac in nine, infracardiac in one case and mixed in one. Deep hypothermia and circulatory arrest were used in 23 cases (74%). In supracardiac type cases the atrial septal defect was closed through the left atriotomy, without enlargement of the left atrium. Extubation in the operating room was possible in 26 cases (84%). Three patients (9.6%) died, one (with connection to the coronary sinus) soon after operation, due to a management error, another (with connection to the right superior vena cava) of pulmonary edema, and an infant with mixed-type connection 1 week postoperatively, presumably from an arrhythmia. No patient required reoperation because of late pulmonary venous stenosis. There were no late deaths. The technique of elevating the cardiac apex provided excellent exposure in the supracardiac and infracardiac types. Progressively earlier referral during the study period facilitated prompt operation and improved patient salvage.