RITORNO VENOSO POLMONARE ANOMALO TOTALE. OSSERVAZIONI CLINICHE E CHIRURGICHE SU 14 CASI

14 patients with total anomalous pulmonary venous drainage, all in serious clinical condition and under development, were studied and operated during the last 4 yr. Cyanosis was not constant; in 10 patients a pulmonary systolic murmur was present. The ECG showed in all cases right ventricular strain; right axis deviation (except in 1 case with associated atrioventricular canal and another with complex malformations). The typical radiological picture of supradiaphragmatic return was seldom present. At cardiac catheterization almost all cases showed pulmonary hypertension with raised pulmonary resistance. In a few cases angiocardiography demonstrated the presence of pulmonary venous obstruction particularly in those with intracardiac return. Angiography made it possible also to locate the associated anomalies of systemic venous return which is essential for the surgical correction. The authors emphasize the exceptional importance of the preoperative treatment (digitalization, respiratory assistance, etc.). Raskind's septostomy was not very useful. Attempts of palliative surgery (anastomosis between common venous truncus and left atrium) were disappointing. Good results were obtained with early radical surgery using deep hypothermia with circulatory arrest and partial bypass (sometimes using total hemodilution). These results were apparently related to the type of venous pulmonary return, as well as the age and weight of the patients. The mortality was 100% in the infracardiac group and 50% in the other groups; the highest mortality was recorded in the subjects with elevated pulmonary pressure/systemic pressure ratio whereas there was only little correlation with the level of aortic saturation. The associated malformations made the prognosis more severe.