Introduction:

Pulmonary venous obstruction (PVO) is a rare and notable complication following conventional surgical repair for total anomalous pulmonary venous connection. It is frequent when the drainage is into coronary sinus (CS) or to cavo-atrial junction (CAJ) at superior vena cava (SVC) to Right atrial (RA)junction. Traditional methods like direct intra-atrial anastomosis often are hampered by the lack of growth between vertical vein and coronary sinus or at CAJ during the follow up. We herewith present our innovative dual drainage repair (DDR) resulting in nonobstructive drainage of pulmonary veins with growth potential that uniformly eliminated the risk of obstruction in the intermediate term follow up.

Methods:

82 patients with de novo TAPVC underwent surgery at our institution between September 2015 and June 2025. The mean age and weight were 6.6 months (7 day - 2 years) and 4.25 kg (range 2-8) respectively. Among them 52 were supra-cardiac (63%), 15 cardiac (18%), and 15(18%) were infra-cardiac or mixed variety. Among these, 9 (13%) underwent the DDR. 6 had drainage to CAJ and while 3 drained to CS (based on the size of communication between CS and vertical vein). Complete repair was done under standard cardiopulmonary bypass techniques. Primary communication was accomplished with direct anastomosis between LA appendage and common venous chamber on the left hilar while the intra-atrial tunnelling through the enlarged atrial septal defect acted as additional drainage.

Results

Mean bypass & clamp time was 111 minutes (range 80- 234) and 62 minutes (range 44 - 114). There was no mortality. All are well in the follow up period. Mean follow-up was 37 months (range 6-108). All are in sinus rhythm and serial echos in the intermediate term showed no stomal obstruction.

Conclusion

DDR is effective in eliminating recurrent PVO in the intermediate term by creating 2 effective pathways.

Dr. Monisha Madanmohan is a distinguished Cardiovascular and Thoracic Surgeon specializing in Pediatric Cardiac Sciences. She currently serves as an Associate Consultant at the prestigious Sir H.N. Reliance Foundation Hospital & Research Centre. A testament to her dedication, she was recently honoured with the 'Women Super Achiever Award' for excellence and leadership in healthcare. During her training, she was actively involved in research focused on palliative procedures for pediatric congenital heart diseases.

Dr. Monisha Madanmohan is now focused on advancing her career by pursuing opportunities to practice surgery in the United States, bringing her specialized expertise to a global stage.