[The results of surgical treatment of total anomalous pulmonary venous return in neonates].

By the time, the results of surgical treatment for total anomalous pulmonary venous return have been unsatisfactory. From 1981, we changed a surgical procedure fro Gersony-Malm procedure to the posterior approach method, and a surgical technique from the deep hypothermia and the circulatory arrest to the moderate hypothermia and the pump perfusion. Consequently, the results of surgical treatment was improved. From 1981 to 1987, 18 neonates with total anomalous pulmonary venous return underwent corrective operations in our institute. This diagnosis was decided by echocardiography without cardiac catheterization, because the preoperative status of these neonates were poor. Under the cardiopulmonary bypass, we performed the posterior approach method for type I and III, the cut-back method and Van Praagh procedure for II and IV without aortic clamping. According to the posterior approach method, the atrial septal defect was closed through the left atrial incision and the left atrium was anastomosed to the common pulmonary trunk during ventricular fibrillation. The incision was limited within the common pulmonary trunk or the vertical vein and was not extended into the pulmonary veins. According to cut-back method and Van Praagh procedure, the coronary sinus was closed internally so as to avoid the postoperative conduction disturbance. There were four hospital deaths (22.2%). The causes of deaths were pulmonary hypertension in two, low cardiac output in one, and intracranial bleeding in one. From the results of our institution, we concluded that the primary factors determining the outcome were the condition of the patients prior to repair and the severity of pulmonary hypertension.