pediatrics
Total Anomalous Pulmonary Venous Return (TAPVR)
Treatment of TAPVR
Surgical repair Medical treatment of heart failure (eg, diuretics,digoxin, angiotensin-converting enzyme inhibitors) before surgery Neonates with total anomalous pulmonary venous return with obstruction require emergent surgical repair. In older infants, Heart failure in older infants and children should be treated, followed by surgical repair as soon as the infant is stabilized. Surgical repair consists of creating a wide anastomosis between the pulmonary venous confluence and the posterior wall of the left atrium. Ligation of the vein decompressing the confluence into the systemic venous circulation is important to prevent a postoperative left-to-right shunt. The repair is different for return to the coronary sinus, in which case the coronary sinus is unroofed into the left atrium and its opening to the right atrium is closed. Prevention is recommended preoperatively but is required only for the first 6 months after repair unless there is a residual defect adjacent to a surgical patch or prosthetic material. 