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.