[A case report of total anomalous pulmonary venous drainage corrected with Vargas' method]

A 50-day-old infant with Darling's type Ib of total anomalous pulmonary venous drainage (TAPVD) was operated on with the Vargas' method. Pulmonary veins drained separately into the right superior vena cava (SVC). A J-shaped right atriotomy was performed according to the Vargas' method. The posterior flap was sutured to the anterior border of a previously enlarged atrial septal defect, directing the pulmonary blood flow toward the left atrium. The right SVC was divided just above the site of drainage of pulmonary veins, the proximal end of the right SVC was closed, and the anastomosis between the distal end of the right SVC and the previously opened right atrial appendage was performed. However, pulmonary hypertension remained because of the restrictive orifices of pulmonary venous drainage into SVC, and then side-to-side anastomoses between pulmonary veins and left atrium had to be added. Eight months after the operation pulmonary hypertension progressed markedly, because the orifices of the anastomoses became severely stenotic. Re-operation was performed to create a large anastomosis between pulmonary veins and left atrium. The indication and the long-term prognosis of the Vargas' method were discussed.