Inferior vena cava division to access post-repair pulmonary venous obstruction

Post-repair pulmonary venous obstruction is a complication that may occur after surgical repair of total anomalous pulmonary veins. Obstruction may occur at the site of surgical anastomosis or it may be intrinsic to the pulmonary veins. The optimal approach to post-repair pulmonary venous obstruction remains controversial because of high mortality rates and persistent risk of re-stenosis. We present a previously undescribed, inferior approach to anastomotic post-repair pulmonary venous obstruction. This approach allowed easy access and excellent visualization of the pulmonary confluence. Three years after the reoperation, the patient had a widely patent confluence-to-left atrial anastomosis.