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Brain & Heart Left PAPVC to left atrial appendage anastomosis

A B C

Figure 5. Intraoperative photos of Case 2. (A) Left-sided pulmonary veins (indicated by 1 and 2) draining to the vertical vein (VV). (B) Ligated VV
(transverse arrow) and opened left atrial appendage (vertical arrow). (C) Anastomosis between VV and left atrial appendage (transverse arrow).

of vertical vein and to facilitate an uncluttered and wide Funding
anastomosis using a finer polypropylene suture.
None.
To conduct the same surgical treatment for both
adults and neonates, it is advisable to perform resection Conflict of interest
of left atrial appendage trabeculations and creation of a The authors declare no conflicts of interest.
left pericardial slit to support the suture line. A slit in the
left pericardial edge can prevent tension from building Author contributions
up on the vertical vein-left atrial appendage suture line.
Caution should be exercised while creating the slit to avoid Conceptualization: Gananjay G. Salve, Parishwanath B. Patil
injuring the left phrenic nerve. This step is particularly Investigation: Danish A.K. Memon, Mohan D. Gan
critical if the left atrial appendage is short. Furthermore, Writing – original draft: Gananjay G. Salve, Danish A.K.
a slit in the adjacent pericardium may ensure long-term Memon, Richard Saldanha
patency of the anastomosis. In relation to this, it is advisable Writing – review & editing: All authors
to start anticoagulation as soon as possible during the Ethics approval and consent to participate
post-operative period, followed by antiplatelet therapy for
3 – 6 months, to avoid late pulmonary venous obstruction. Ethics committee of KLES Academy of Higher Education
and Research, Belgaum granted permission to publish this
Atrial arrhythmias, particularly atrial fibrillation,
remain one of the most common causes of arrhythmia- article. Verbal consent was obtained from the patient prior
related morbidity and mortality. Current treatment options to participation.
for atrial arrhythmias include medical management, Consent for publication
catheter ablation, and surgical procedures. Complex
6
atrial tachycardias can be profiled using ultra high-density A verbal consent was obtained from the involved patients’
mapping, which is a is safe, feasible, and effective avenue for before writing the manuscript. No patient identifiable data
precisely identifying tachycardia sites to guide successful have been mentioned in the manuscript.
catheter ablation. To ease such catheter procedures, if
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indicated in future, a wide anastomosis of the vertical vein Availability of data
to the left atrial appendage is necessary. Data are available from the corresponding author on
reasonable request.
4. Conclusion
Vertical vein-left atrial appendage anastomosis for PAPVC References
is a patient-centric approach, requiring cautious attention 1. Healey JE Jr. An anatomic survey of anomalous
of the attending surgeons. The prime objective while pulmonary veins: Their clinical significance. J Thorac Surg.
conducting the surgical repairs is to avoid pulmonary 1952;23:433-444.
venous obstruction by following procedures featuring 2. Javangula K, Cole J, Cross M, Kay PH. An unusual
technical nuances targeting different age groups. manifestation of left partial anomalous pulmonary
venous connection. Interact Cardiovasc Thorac Surg.
Acknowledgments 2010;11:846-847.
None. doi: 10.1510/icvts.2009.231100

Volume 2 Issue 2 (2024) 4 doi: 10.36922/bh.2376