ELIZABETH STEPHENS: My name is Elizabeth Stephens. I'm a pediatric and congenital cardiac surgeon at Mayo Clinic. Today, I'll be covering repair of total anomalous pulmonary venous return. In this video, we demonstrate the surgical technique for repair. This is a 2.4 kilo two-day-old. Here, the chest is open.

We proceed to put the cannulas in place to put the baby on the heart-lung machine. And here, the blood is starting to flow to the machine. You can appreciate how tiny the heart is. Now, we are tying off the patent ductus arteriosus, which is a shunt in utero that isn't needed once the baby is born.

Now, we are flipping the heart into the right chest to access the back side of the heart where this confluence of the pulmonary veins is. This diagram shows the anatomy with a common chamber containing the veins behind the left atrium. We are dissecting out this pulmonary venous confluence.

Now, we are entering the confluence. You can see on either side the pulmonary veins entering the confluence. We are dissecting out further to create a large enough opening for the anastomosis.

This diagram depicts the opening in the chamber of the primary veins, as well as that in the left atrium. Here we are opening the left atrium. And you can see the tip of a catheter. Now, we are suturing the pulmonary venous confluence to the left atrium. This will allow the blood to return back to the left side of the heart normally. We use very fine suture,

The vertical vein will then be tied off because that vein is no longer needed to get the blood back to the heart. This diagram shows the final results of the anastomosis. Now, we are opening the right atrium. And you can see a small hole between the right and left sides of the heart, patent foramen ovale. We are closing this.

Now, we are closing the right atrium. And we start to bring the baby off the heart-lung machine. Shown here is the final result as the heart is starting to beat again.