Surgical anastomosis of vertical vein to left atrial appendage: A case report of technical aspects

Management of partial anomalous pulmonary venous connection (PAPVC) differs significantly between the defect on the left side, which is adjacent to left atrial appendage, and that on the right one adjacent to the interatrial septum. Here, we report two patients operated at our center. The first case is an adult diagnosed with the left-sided PAPVC draining to an innominate vein through a left-sided vertical vein, and with a large ostium secundum atrial septal defect. The second case is a neonate with mixed-type total anomalous pulmonary venous connection with all right pulmonary veins opening into the coronary sinus, and all the left pulmonary veins connecting to the innominate vein through a left-sided vertical vein. Both patients experienced severe pulmonary arterial hypertension, necessitating surgical treatment involving disconnection of the vertical vein from its junction, or, ligation of the vertical vein-innominate vein junction, coupled with its redirection to the left atrial appendage. We employed different surgical procedures on these patients, given the distinct age difference, intending to anastomose their respective vertical veins to the adjacent left atrial appendage. In this report, the technical aspects of anastomosing vertical vein to left atrial appendage, to avoid pulmonary venous obstruction in these two patients, are discussed.