An Unusual Cause of Common Chamber to LA Anastomosis Obstruction in Supracardiac TAPVC

This report details a rare cause of early postoperative pulmonary venous obstruction following supracardiac total anomalous pulmonary venous connection repair in a 4-week-old infant. Despite a successful sutureless anastomosis, intraoperative transesophageal echocardiography revealed significant flow acceleration (1.69 m/s and a mean gradient of 5 mm Hg). Surgical inspection identified that the left atrial appendage (LAA) was sagging over the common chamber-to-left atrial anastomosis, causing an obstruction. The mechanical obstruction was relieved by suturing the LAA to the undersurface of the left pleural cavity, which prevented further sagging onto the anastomosis.