[Surgical treatment of total anomalous pulmonary venous connection under three months of age].

Nine infants under 3 months of age with total anomalous pulmonary venous connection underwent total correction between June, 1986 and September, 1988. The age at operation ranged from 4 days to 59 days, averaging 19 days, and the body weight ranged from 1,814 g to 4,105 g, with a mean of 3,050 g. The types of TAPVC were Darling Ia in 4, Ib in 1 and III in 4. All the patients were operated by the posterior approach under cardiopulmonary bypass with high flow (130-200 ml/kg/min) and mild hypothermia using modified GIK-cardioplegia, topical cooling and aortic cross clamping. Although the incision in the common pulmonary vein trunk was never extended into the pulmonary veins or vertical vein, the length of the mouth was at least 10 mm. In the postoperative management, care was taken to avoid overhydration and rapid volume infusion. Blood pressure was kept just enough to maintain urine output. Heart rate was kept over 170/min for early postoperative days with the use of isoproterenol or atrial pacing. There was no operative or late death. Postoperative course was uneventful in all cases except one with low output syndrome in which mechanical ventilation for 8 days was required. Postoperative catheterization and angiography revealed normal intracardiac pressure values and no pulmonary venous obstruction in all cases. Follow-up period ranged from 10 to 37 months, and there has been no patient with the signs of PVO.