Management
Surgery was performed through full median sternotomy. The absence of the
left brachiocefalic vein was confirmed. The LSVC entered the LA cephalad
and medial to the left superior pulmonary vein (Fig 3 and Fig 4).
Cardiopulmonary bypass was established, with bicaval cannulation for
venous drainage. The aorta was crossclamped and the heart was arrested
with a single shot of cold histidine-tryptophan-ketoglutarate (HTK)
solution delivered in antegrade fashion. The right atrium was opened and
the ostium of the LSVC was examined through the large ASD. The close
proximity of the ostium of the LSVC to the ostium of the left superior
pulmonary vein precluded the placement of an interatrial baffle,
therefore the ASD was closed with an autologous pericardial patch. The
LSVC was divided, its distal end ligated and its proximal end
anastomosed to the right atrium with the interposition of a 16mm
Gore-Tex vascular graft (Gore, Tempe, AZ)(Fig 3). The patient had an
uneventful postoperative course and made a full recovery. Four years
following surgery, he is in excellent general condition and the
echocardiogram shows no residual shunt, with a normal right ventricle
and normal pulmonary pressures.