AccScience Publishing / BH / Volume 2 / Issue 2 / DOI: 10.36922/bh.2376

Surgical anastomosis of vertical vein to left atrial appendage: A case report of technical aspects

Gananjay G. Salve1* Danish A.K. Memon1 Veeresh Manvi1 Parishwanath B. Patil1 Nidhi G. Manvi1 Mohan D. Gan1 Richard Saldanha1
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1 Department of Cardiovascular and Thoracic Surgery, KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka, India
Brain & Heart 2024, 2(2), 2376
Submitted: 5 December 2023 | Accepted: 27 February 2024 | Published: 2 May 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Management of partial anomalous pulmonary venous connection (PAPVC) differs significantly between the defect on the left side, which is adjacent to left atrial appendage, and that on the right one adjacent to the interatrial septum. Here, we report two patients operated at our center. The first case is an adult diagnosed with the left-sided PAPVC draining to an innominate vein through a left-sided vertical vein, and with a large ostium secundum atrial septal defect. The second case is a neonate with mixed-type total anomalous pulmonary venous connection with all right pulmonary veins opening into the coronary sinus, and all the left pulmonary veins connecting to the innominate vein through a left-sided vertical vein. Both patients experienced severe pulmonary arterial hypertension, necessitating surgical treatment involving disconnection of the vertical vein from its junction, or, ligation of the vertical vein-innominate vein junction, coupled with its redirection to the left atrial appendage. We employed different surgical procedures on these patients, given the distinct age difference, intending to anastomose their respective vertical veins to the adjacent left atrial appendage. In this report, the technical aspects of anastomosing vertical vein to left atrial appendage, to avoid pulmonary venous obstruction in these two patients, are discussed.

Anomalous pulmonary venous connection
Vertical vein
Left atrial appendage
Secundum atrial septal defect
Technical aspects
  1. Healey JE Jr. An anatomic survey of anomalous pulmonary veins: Their clinical significance. J Thorac Surg. 1952;23:433-444.


  1. Javangula K, Cole J, Cross M, Kay PH. An unusual manifestation of left partial anomalous pulmonary venous connection. Interact Cardiovasc Thorac Surg. 2010;11:846-847. doi: 10.1510/icvts.2009.231100


  1. Bharati S, Lev M. Congenital anomalies of the pulmonary veins. Cardiovasc Clin. 1973;5:23-41.


  1. Darling RC, Rothney WB, Craig JM. Total pulmonary venous drainage into the right side of the heart; report of 17 autopsied cases not associated with other major cardiovascular anomalies. Lab Invest. 1957;6:44-64.


  1. Delius RE, De Leval MR, Elliot MJ, Stark J. Mixed total pulmonary venous drainage: Still a surgical challenge. J Thorac Cardiovasc Surg. 1996;112:1581-1588. doi: 10.1016/S0022-5223(96)70017-X.6


  1. MacGregor RM, Khiabani AJ, Damiano RJ Jr. The surgical treatment of atrial fibrillation via median sternotomy. Oper Tech Thorac Cardiovasc Surg. 2019;24:19-37. doi: 10.1053/j.optechstcvs.2019.07.001


  1. Schaeffer B, Hoffmann BA, Meyer C, et al. Characterization, mapping, and ablation of complex atrial tachycardia: Initial experience with a novel method of ultra high-density 3D mapping. J Cardiovasc Electrophysiol. 2016;27:1139-1150. doi: 10.1111/jce.13035
Conflict of interest
The authors declare no conflicts of interest.
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Brain & Heart, Electronic ISSN: 2972-4139 Published by AccScience Publishing