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.