This report details a rare cause of early postoperative pulmonary venous obstruction following supracardiac total anomalous pulmonary venous connection repair in a 4-week-old infant. Despite a successful sutureless anastomosis, intraoperative transesophageal echocardiography revealed significant flow acceleration (1.69 m/s and a mean gradient of 5 mm Hg). Surgical inspection identified that the left atrial appendage (LAA) was sagging over the common chamber-to-left atrial anastomosis, causing an obstruction. The mechanical obstruction was relieved by suturing the LAA to the undersurface of the left pleural cavity, which prevented further sagging onto the anastomosis.
Soni et al. (Wed,) studied this question.