Total Anomalous Pulmonary Venous Drainage II. Spontaneous Functional Closure of Interatrial Communication after Surgical Correction in Infancy

The spontaneous functional closure of the interatrial communication in total anomalous pulmonary venous drainage (TAPVD) subsequent to surgical correction of the TAPVD in infants is reported. Three cases are documented with descriptions of clinical features, cardiac catheterization data, thermodilution curves, and angiography. This evidence suggests that it might be unnecessary in infants to close the interatrial communication at the time of correction of the TAPVD. It also suggests that balloon atrial septostomy may sometimes be unwise before the first-stage correction. Additional Indexing Words: Atrial septal defect, spontaneous closure of Atrial septal defect, size in total anomalous pulmonary venous drainage Thermodilution deternination of shunts IN PATIENTS with total anomalous pul-monary venous drainage (TAPVD) the systemic cardiac output is limited to the volume which can pass through a defect in the interatrial septum. It has been our practice not to close this interatrial communication during the first-stage repair of supracardiac TAPVD in infants. We prefer a later closure as a second-stage operation. On reevaluating our earliest patients who are now approaching school age, we have found clinical evidence that four of these interatrial communications have closed spontaneously. We have reinves-tigated three of these children by cardiac catheterization and angiography. The spontaneous closure of ventricula