Total Anomalous Pulmonary Venous Drainage A Clinical and Anatomical Study of 75 Children

Seventy-five children with total anomalous pul-monary venous drainage have been seen at The Hos-pital for Sick Children, Great Ormond Street, London. Of these, 61 were proved to have this malformation at necropsy and 14 by cardiac cathe-terization, angiocardiography, and operation. The classification of Darling, Rothney, and Craig (1957) according to the site of drainage is used, i.e. supra-cardiac, cardiac, infracardiac, and mixed. For convenience of presentation, but not as a classification, the 75 children may be divided into 2 groups. Those who were uncomplicated by other major cardiac defects numbered 58 (Group I), and those who had major additional cardiac defects num-bered 17 (Group II). Group II may again be divided: Group IIa, those who had asplenia, or gross abnormalities of the spleen; and Group IIb in whom the spleen was normal. The presence of a secundum atrial septal defect is not considered as a major additional cardiac defect for the purpose of this grouping, for its presence is beneficial to the circulation. LIFE EXPECTANCY Fig. 1 shows the aget at death or operation in all these 75 children. Fig. 2 shows the same data in Group I, and Fig. 3 the data in Group II. Of the total, 80 per cent died, or had to be operated upon before the age of 1 year. Even in the uncomplicated Group I, only 25 per cent survived infancy. Fur-ther, all those presenting as neonates died, amount-ing to 15 per cent of Group I. All those in Grou