#Multipatch Patch

The vena cava flow courses anterior to this patch ( blue arrows). E, An autologous pericardial patch is placed to divide the scimitar vein from the IVC and direct flow from the scimitar vein via a relatively straight baffle to the left atrium ( red arrows) effectively closing the atrial septal defect. D, AВ V-shaped incision is made in the atrium and scimitar vein and the space is filled in with a thin pulmonary homograft. The left atrium is pulled downward and anastomosed to the right atrial tissue bringing the left atrium closer to the scimitar vein. C, The atrial septum and superior limbic band have been resected. The atrial septum (1) and superior limbic band (2) are imaged. B, An incision is made in the right atrium and IVC to identify the origin of the scimitar vein. A, Baseline anatomy showing scimitar vein connecting to the IVC superior to the level of the diaphragm and intact atrial septum. Triple patch operative technique to repair scimitar syndrome. Patients having only the multipatch procedure for repair of scimitar syndrome have not developed postoperative pulmonary vein obstruction in the short to intermediate term.Д¬MR, cardiac magnetic resonance IVC, inferior vena cava congenital heart disease partial anomalous pulmonary venous return pulmonary vein stenosis scimitar syndrome. None of the 11 patients who only had the new procedure developed pulmonary vein obstruction during postoperative monitoring up to 3.6 years. Of the 11 patients who had baffling or reimplantation, 5 developed pulmonary vein obstruction between 45 days and 9.5 months after surgery associated with baffle thrombosis or tension on the pulmonary vein. A patch of autologous pericardium was used to septate the atrium and an additional patch placed anteriorly to augment the inferior vena cava. If the scimitar vein coursed adjacent to the atrium, a V-shaped incision was made into the scimitar vein and directly anastomosed to the atrium. The left atrium was pulled down toward the scimitar vein and a V-shaped incision made at the scimitar vein atrial junction with the space filled with a pulmonary homograft. We analyzed the results of a new operation that enlarges the left atrium and avoids circuitous pathways or tension on the scimitar pulmonary vein.Д«etween April 2011 and November 2018, 22 patients underwent scimitar vein surgery 11 had baffling or reimplantation and 11 only had the new operation that included resection of the atrial septum with removal of the muscular limbus. A review of our center's experience before March 2011 showed that one half of 36 patients who had a baffling or reimplantation procedure to repair scimitar syndrome developed pulmonary vein obstruction.

Multipatch