#Junior multipatch Patch
This space was patch augmented with a thin pulmonary homograft with running polypropylene suture in an L-shaped fashion effectively enlarging the left atrium, taking any tension or torsion off the scimitar vein so as not to pull it too tightly to the left atrium, and shortening the scimitar pulmonary venous pathway. A right lateral atriotomy in the posterior part of the right atrium was made and opened down at a right angle into the scimitar vein creating a V-shaped incision ( Figure 2, D). The back wall of the left atrium was pulled rightward and downward toward the IVC to shorten the distance from the scimitar vein ( Figure 2, C, insert) and run together with interlocking polypropylene suture. This resection included the back wall of the left atrium to that the heart was exited posteriorly. The atrial septum was fully resected critically removing the area of the muscular limbus ( Figure 2, B and C). If the scimitar vein was near the right atrial–IVC junction, an IVC cannula was placed inferiorly in a typical position if the scimitar vein entered at or below the diaphragm, an open-drop suction catheter was used. Cardiopulmonary bypass was established, cardioplegia administered, and diastolic arrest achieved.
Autologous pericardium was harvested, fixed for 2 minutes in 0.6% glutaraldehyde, and rinsed. The novel surgical technique incorporated a double- or triple-patch repair depending on the distance between the scimitar vein and atrial tissue ( Figures 2 and 3).
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