Sutureless pericardial repair of total anomalous pulmonary venous connection in patients with right atrial isomerism.

Surgical repair of total anomalous pulmonary venous connection (TAPVC) in patients with right atrial isomerism is associated with a significant risk of recurrent pulmonary venous obstruction (PVO). We evaluate the effect of sutureless repair to reduce the risk of recurrent PVO. Since November 2007, five patients, including three neonates, with right atrial isomerism underwent sutureless repair of TAPVC. The sutureless repair was used in three neonates as an initial procedure and in two infants as a procedure for postrepair PVO. Under deep hypothermic circulatory arrest or low flow cardiopulmonary bypass, pulmonary vein (PV) was incised as long as possible. The atrial wall was partially resected and anastomosed to the pericardial wall around the incised PV. There were no early deaths. No patients showed recurrence of PVO. There was one late death. Two patients underwent a bidirectional Glenn shunt after the sutureless repair. The pulmonary venous confluence was confirmed to be left open at the time of the Glenn surgery. The sutureless technique may be useful not only for postrepair PVO but also for non-operated TAPVC in neonates with right atrial isomerism.