Surgical approach and management
Although the anomalous course of the vein, in itself, does not mandate
surgical intervention, its presence can affect the surgical technique
when dealing with the associated cardiac anomalies. Its presence may
complicate exposure of pulmonary arteries, for example, when creating a
systemic-to-pulmonary arterial shunt.
Because of its course posterior to ascending aorta or its branches, and
its proximity to adjacent trachea and esophagus, the surgical view may
be limited. Moderately hypothermic cardiopulmonary bypass at 32°C with
cold blood cardioplegia has been the most popular technique used by
several investigators, depending on the associated cardiac anomalies.
Deep hypothermic circulatory arrest has been employed for separate
cannulation of the caval veins, or exposure of the aortic arch or
pulmonary arteries. This technique has also been suggested to be
impractical because of the short superior caval vein, and the small
operating field.5,56,75 The principles of surgery are
dictated by the concomitant cardiac anomalies. Multiple techniques have
been reported.