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The mixed type of total anomalous pulmonary venous connection is the least common variant, occurring in approximately 5% of all patients. Dual drainage through a common venous confluence is much rarer. Computed tomography to delineate the exact pulmonary venous anatomy is a must in such cases. Correct preoperative recognition and intraoperative confirmation to check the drainage of all 4 pulmonary veins is essential in all cases of total anomalous pulmonary venous connection. We report the case of an adult patient with dual drainage to coronary sinus and left vertical vein to innominate vein.

A 4-day-old boy underwent an urgent operation for mixed total anomalous pulmonary venous connection with the left upper pulmonary vein draining into the innominate vein and the other pulmonary veins draining into the coronary sinus. The left upper pulmonary vein was left uncorrected at that time. After periodical follow-up for 5 years, repair of the uncorrected anomalous pulmonary vein was performed. This two-stage operation is a viable option in cases of mixed type total anomalous pulmonary venous connection, leaving the isolated left upper vein uncorrected in the neonatal period, instead of an aggressive full repair., (© The Author(s) 2014.)

We successfully repaired a markedly narrowed coronary sinus without connecting a left superior vena cava in a 3-year-old boy with an atrial septal defect.

Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.