日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Reconstruction of the left superior vena cava (LSVC) is required in biventricular repair when the LSVC drains directly into the left atrium. However, the criteria for reconstruction and a standard method have not been established. We report a case of successful concomitant intra-cardiac repair and LSVC reconstruction using the right atrial wall flap. A 10-month-old girl with a common atrium, an incomplete atrioventricular septal defect, left atrioventricular valve regurgitation, and patent ductus arteriosus presented with severe cyanosis and heart failure. Preoperative angiography showed each superior vena cava (SVC) draining directly into the ipsilateral atrium, with the LSVC larger than the right SVC. With balloon catheter occlusion of the LSVC, the pressure in the LSVC increased from 6 mmHg to 38 mmHg, so simple ligation of the LSVC was considered to be high risk. After intra-cardiac repair, the posterior wall of the LSVC was reconstructed using an atrial wall flap created from the anterior wall of the right side atrium. The anterior wall of the LSVC was enlarged using a fresh autologous pericardial patch. The postoperative recovery was uneventful, with no venous congestion. Reconstruction using an atrial wall flap offers an alternative surgical method for treating patients with a common atrium into which the LSVC drains directly into the left side.