Search

Copyright of Avian Diseases is the property of American Association of Avian Pathologists, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Patients with neuromuscular disorders (NMD) share the risk of acute respiratory failure (ARF) leading to ICU admissions. Noninvasive ventilation (NIV) is often proposed as an alternative to invasive ventilation. This study describes clinical features, ventilation management, and outcomes of subjects with NMD admitted to ICU and managed for ARF. METHODS: We performed a multicenter retrospective study in 7 adult ICUs in the Auvergne-Rhone-Alpes area in France involving subjects with NMD admitted to the ICU for ARF. The primary end point was ICU mortality. Secondary end points were NIV failure, weaning from invasive ventilation, and long-term mortality. We hypothesized a poorer outcome in the case of bulbar musculature involvement. RESULTS: A total of 242 subjects were included; 142 subjects had nonhereditary NMD (58.7%), and 100 had hereditary NMD (41.3%). Eleven subjects had home ventilation through a tracheostomy. While 112 were intubated at admission, 119 initially underwent NIV. NIV was successful in avoiding orotracheal intubation in 78 subjects (65.5%). ICU mortality was 13.6%. Factors associated with ICU mortality were nonhereditary NMD and requirement for invasive ventilation. The involvement of bulbar musculature in ARF and hereditary NMD were associated with NIV failure. After a median follow-up of 1.2 y, 53 of 209 subjects had died. CONCLUSIONS: The ICU mortality of NMD subjects with ARF was low, with no impact of bulbar muscles involvement. NIV was proposed for approximately half of the subjects, and it was more effective when ARF was not attributed to bulbar musculature involvement. The long-term outcome was good. [ABSTRACT FROM AUTHOR]

BACKGROUND: We hypothesized that the lack of benefit of setting a low versus a high PEEP in patients with ARDS may be due in part to differences in the dynamic behavior of the expiratory valve in ventilators. We tested this hypothesis by conducting a bench comparison of the dynamic behavior of expiratory valves on ICU ventilators currently in use. METHODS: We attached 7 ICU ventilators (C5, C6, Carescape, PB980, ServoU, V500, and V680) to the ASL 5000 lung model (passive condition with compliance 20 mL/cm H2O and resistance 5 cm H2O/L/s) and set in volume controlled mode (tidal volume 0.8 L, breathing frequency 10 breaths/min). Flow and pressure were measured just before the exhalation valve. At PEEP of 5, 10, and 15 cm H2O, the median instantaneous expiratory resistance, the time to valve opening, and the pressure time products above or below the values of PEEP (expressed in cm H2O x s) were determined. RESULTS: Median instantaneous expiratory resistance values differed between the ventilators and PEEP settings with a significant interaction: at PEEP 5 cm H2O, the median (interquartile range) expiratory resistance values were 3.9 (3.5-4.7), 3.0 (3.0-3.1), 20.9 (15.8-24.9), 27.4 (26.5-43.2), 13.8 (13.6-13.9), 4.4 (4.0-4.6), and 34.3 (33.7-33.8) cm H2O/L/s, for the C5, C6, Carescape, PB980, ServoU, V500, and V680, respectively. For all the PEEP settings, the corresponding times to valve opening were 0.080 (0.077-0.082), 0.082 (0.080-0.085), 0.110 (0.105-0.110), 0.100 (0.085-1.05), 0.072 (0.062-0.072), 0.145 (0.115-0.150), and 0.075 (0.070-0.080) s, respectively, and pressure-time products were 2.8 (2.1-7.4), 6.8 (6.7-7.3), 2.4 (2.1-2.4), 3.5 (2.7-3.6), 1.8 (1.8-2.1), 2.8 (2.7-2.9), and 5.7 (5.4-5.9) cm H2O x s, respectively. CONCLUSIONS: The resistance of active expiratory valves differed significantly between the 7 ICU ventilators tested. [ABSTRACT FROM AUTHOR]

BACKGROUND: Obesity-hypoventilation syndrome (OHS) is defined as the combination of obesity (body mass index ≥ 30 kg/m²) and daytime arterial hypercapnia (PaCO2 > 45 mm Hg) in the absence of other causes of hypoventilation, and can lead to acute hypercapnic respiratory failure in the ICU. Our objective was to describe the ventilatory management and outcomes of subjects with OHS who were admitted to the ICU for acute hypercapnic respiratory failure. METHODS: We retrospectively built a cohort of subjects with OHS who were admitted for acute hypercapnic respiratory failure in 4 ICUs of the university teaching hospital in Lyon, France, between 2013 and 2017. The main end point was the rate of success of noninvasive ventilation (NIV). Secondary end points were survival from OHS diagnosis to the last follow-up and risk factors for ICU admission and long-term survival. RESULTS: One hundred fifteen subjects with OHS were included. Thirty- seven subjects (32.1%) were admitted to the ICU for acute hypercapnic respiratory failure. Con- gestive heart failure was the leading cause of acute hypercapnic respiratory failure (54%). At ICU admission, pH before NIV use was median (range) 7.26 (7.22-7.31) and ... was 70 (61-76) mm Hg. NIV was used as first-line ventilatory support in 36 subjects (97.2%) and was successful in 33 subjects (91.7%). ICU mortality was low (2.7%). The subjects admitted to the ICU were significantly older and had a lower FEV1 and vital capacity at the time of an OHS diagnosis. The difference in the restricted mean survival time was 663 d in favor of subjects not admitted to the ICU. Multivariate analysis showed that lower vital capacity at an OHS diagnosis was significantly associated with a higher risk of ICU admission. No factor was independently associated with long-term overall mortality in multivariate analysis. CONCLUSIONS: Acute hypercapnic respiratory failure in subjects with OHS was generally responsive to NIV and was frequently associated with congestive heart failure. [ABSTRACT FROM AUTHOR]

BACKGROUND: Successful weaning from mechanical ventilation depends on the patient's ability to cough efficiently. Cough peak flow (CPF) could predict extubation success using a dedicated flow meter but required patient disconnection. We aimed to predict extubation outcome using an overall model, including cough performance assessed by a ventilator flow meter. METHODS: This was a prospective observational study conducted from November 2014 to October 2015. Before and after a spontaneous breathing trial, subjects were encouraged to cough as strongly as possible before freezing the ventilator screen to assess CPF and tidal volume (VT) in the preceding inspiration. Early extubation success rate was defined as the proportion of subjects not re-intubated 48 h after extubation. Diagnostic performance of CPF and VT was assessed by using the area under the curve of the receiver operating characteristic curve. Cut-off values for CPF and VT were defined according to median values and used to describe the performance of a predictive test combining them with risk factors of early extubation failure. RESULTS: Among 673 subjects admitted, 92 had a cough assessment before extubation. For the 81 subjects with early extubation success, the median CPF was -67.7 L/min, and median VT was 0.646 L. For the 11 subjects with early extubation failure, the median CPF was -57.3 L/min, and median VT was 0.448 L. Area under the curve was 0.61 (95% CI 0.37-0.83) for CPF and 0.64 (95% CI 0.42-0.84) for CPF/VT combined. After dichotomization (CPF < -60 L/min or VT > 0.55 L), there was a synergistic effect to predict early extubation success (P < .001). The predictive value of success reached 94.2% for CPF/V T combined. The overall model including pH before extubation < 7.45 reached a 66.7% predictive value of failure. CONCLUSIONS: CPF measured using the flow meter of an ICU ventilator was able to predict extubation success and to build a composite score to predict extubation failure. The results were close to that found in previous studies that used a dedicated flow meter. This could help to identify high-risk subjects to prevent extubation failure. [ABSTRACT FROM AUTHOR]

Copyright of Avian Diseases is the property of American Association of Avian Pathologists, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: The present study explored the role of closing volume as a determinant of orthopnea in stable obese subjects. We hypothesized that: (1) increase in closing volume in supine position would be greater in orthopneic than in non-orthopneic subjects, and (2) the relationship of change in closing volume to change in dyspnea with position would be dependent on expiratory flow limitation in the sitting position. METHODS: In stable obese subjects, in sitting and supine positions, we measured the Borg dyspnea score, static lung volumes, expiratory flow limitation during tidal breathing, and single-breath nitrogen expiration test. From the latter, we determined closing volume and closing capacity, slope of phase III, and opening capacity. Orthopnea was defined as any increase in the Borg score in the supine position from its value in the sitting position. RESULTS: Twenty-one subjects (13 women), median age (interquartile range) 55 (49-57) y and with body mass index of 39 (38-42) kg/m² were included, of whom 12 were orthopneic and 11 had expiratory flow limitation while seated. In the sitting position, orthopneic and non-orthopneic subjects were similar for age, body mass index, and pulmonary function tests, including single-breath nitrogen expiration test-derived variables. In the orthopneic subjects, there were no changes in any respiratory variable between positions. In the non-orthopneic subjects, there was a significant decrease in slope of phase III in the supine position from 1.67 (1.33-3.60) to 1.40 (1.25-1.66)%/L (P = .008). Overall, the subjects' Borg score significantly correlated with the slope of phase III (r = 0.63, P = .002) and opening capacity (r = -0.47, P = .03). In 10 subjects without expiratory flow limitation, it correlated with slope of phase III (r = 0.68, P = .03). CONCLUSIONS: In stable obese subjects, magnitude of orthopnea correlated with an increase in the slope of phase III in subjects without expiratory flow limitation. Expiratory flow limitation should be taken into account in obese patients. [ABSTRACT FROM AUTHOR]

Locating groundwater in deep-seated karst aquifers is inherently difficult. With seismic methods, we studied the upper epikarst and the underneath low-permeability volume (LPV) of several karst systems located in the southern Quercy and Larzac regions of France and found that refraction tomography was effective only in the epikarst and not in the LPV. We evaluated a 3D case study using a combination of surface records and downhole receivers to overcome this limitation. This 3D approach unveiled a set of elongated furrows at the base of the epikarst and identified heterogeneities deep inside the LPV that may represent high-permeability preferred pathways for water inside the karst. To achieve the same result when no borehole was available, we studied seismic amplitudes of the wavefield, recognizing that wave-induced fluid flow in low-permeability carbonates is a driving mechanism of seismic attenuation. We developed a workflow describing the heterogeneity of the LPV with spectral attributes derived from surface-consistent decomposition principles, and we validated its effectiveness at benchmark locations. We applied this workflow to the 3D study and found a low-amplitude signal area at depth; we interpreted this anomaly as a water-saturated body perched above the aquifer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intermittent positive pressure breathing (IPPB) is used in non-intubated patients to increase lung volume and to enhance coughing. Alpha 200 (Salvia Lifetec, Kronberg, Germany) is a specific IPPB device. CoughAssist (Respironics France, Carquefou, France) is a mechanical insufflator-exsufflator used to remove secretions in patients with inefficient cough. Both can also be used for intubated or tracheotomized patients. We assessed the impact of various artificial airways on the ability of the Alpha 200 and CoughAssist to generate insufflated volume. METHODS: We measured the insufflated volume and pressure at the airway opening in a lung model under 2 conditions of compliance (30 or 60 mL/cm H2O) at single resistance of 5 cm H2O/L/s. The devices were used at 2 set pressures: 30 and 40 cm H2O. The Alpha 200 was set at 2 inflation flows: 0.5 and 1 L/s, whereas CoughAssist was set at its highest value of 10 L/s. Measurements were done without (control) and with different size endotracheal tubes and tracheostomy cannulae. The relationships between insufflated volume and measured pressure were analyzed using linear regressions. RESULTS: The slopes and intercepts of the control relationship between insufflated volume and pressure were significantly greater with Alpha 200 at each set flow than with CoughAssist. As artificial airways were used, the insufflated volume did not differ from the control with CoughAssist, while with Alpha 200 it increased at each flow setting and for all mechanical conditions. The largest differences in insufflated volume between the 2 devices were observed for the largest endotracheal tubes and tracheostomy cannulas and for the lowest inflation flow setting in Alpha 200. These results can be explained in terms of how the devices function, as CoughAssist adapts by increasing flow, while Alpha 200 adapts by increasing inspiratory time. CONCLUSIONS: This bench study has shown that in the presence of artificial airways the value of the insufflated volume generated by the CoughAssist device was significantly lower than that generated by the Alpha 200 device. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Stewart approach theorizes that plasma pH depends on PaCO2, the strong ion difference, and the plasma total concentration of non-volatile weak acids (Atot). The conventional approach measures standardized base excess, bicarbonate (HCO3‾), and the anion gap. OBJECTIVE: To describe acid-base disorders with the Stewart approach and the conventional approach in patients with chronic respiratory failure. METHODS: This was an observational prospective study in a medical intensive care unit and a pneumology ward of a university hospital. There were 128 patients included in the study, of which 14 had more than one admission, resulting in 145 admissions. These were allocated to 4 groups: stable respiratory condition and elevated HCO3‾ (Group 1, n = 23), stable respiratory condition and non-elevated HCO3‾ (Group 2, n = 41), unstable respiratory condition and elevated HCO3‾ (Group 3, n = 44), and unstable respiratory condition and non-elevated HCO3‾ (Group 4, n = 37). Elevated HCO3‾ was defined as ≥ 3 standard deviations higher than the mean value we found in 8 healthy volunteers. Measurements were taken on admission. RESULTS: In groups 1, 2, 3, and 4, the respective mean ± SD values were: HCO3‾ 33 ± 3 mM, 26 ± 3 mM, 37 ± 4 mM, and 27 ± 3 mM (P < .001); strong ion difference 45 ± 3 mM, 38 ± 4 mM, 46 ± 4 mM, and 36 ± 4 mM (P < .001); and Atot 12 ± 1 mM, 12 ± 1 mM, 10 ± 1 mM, 10 ± 2 mM (P < .001). Non-respiratory disorders related to high strong ion difference were observed in 12% of patients with elevated HCO3‾, and in none of those with non-elevated HCO3‾ (P = .003). Non-respiratory disorders related to low strong ion difference were observed in 9% of patients with non-elevated HCO3‾, and in none of those with elevated HCO3‾ (P = .02). Hypoalbuminemia was common, especially in unstable patients (group 3, 66%; group 4, 65%). Normal standardized base excess (16%), HCO3‾ (28%), and anion gap (30%) values were common. The Stewart approach detected high effective strong ion difference in 13% of normal standardized base excess, and in 20% of normal anion gap corrected for albuminemia, and low effective strong ion difference in 22% of non-elevated HCO3‾. CONCLUSIONS: In patients with chronic respiratory failure the acid-base pattern is complex, metabolic alkalosis is present in some patients with elevated HCO3‾, and metabolic acidosis is present in some with non-elevated HCO3‾. The diagnostic performance of the Stewart approach was better than that of the conventional approach, even when corrected anion gap was taken into account. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bulletin des bibliothèques de France is the property of ENSSIB and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Psychologie du Travail et des Organisations is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The COCCINELLE study is a nationwide retrospective French cohort set up to evaluate the risk of cancer in patients who undergone cardiac catheterisation (CC) procedures for diagnosis or treatment of congenital heart disease during childhood., Participants: Children who undergone CC procedures from 1 January 2000 to 31 December 2013, before the age of 16 in one of the 15 paediatric cardiology departments which perform paediatric CC in mainland France were included. The follow-up started at the date of the first recorded CC procedure until the exit date, that is, the date of death, the date of first cancer diagnosis, the date of the 18th birthday or the 31 December 2015, whichever occurred first. The cohort was linked to the National Childhood Cancer Registry to identify patients diagnosed with cancer and with the French National Directory for the Identification of Natural Persons to retrieve the patients' vital status., Findings to Date: A total of 17 104 children were included in the cohort and followed for 110 335 person-years, with 22 227 CC procedures collected. Among the patients, 81.6% received only one procedure. Fifty-nine cancer cases were observed in the cohort. Standardised incidence ratios (SIRs) were increased for all-cancer (SIR=3.8, 95% CI: 2.9 to 4.9), leukaemia (SIR=3.3, 95% CI: 2.0 to 5.4), lymphoma (SIR=14.9, 95% CI: 9.9 to 22.5) and solid cancers excluding central nervous system (CNS) tumours (SIR=3.3, 95% CI: 2.0 to 5.5) compared with the general population., Future Plans: Dose reconstruction is currently underway to estimate individual cumulative doses absorbed to relevant organs, including red bone marrow and brain for respectively haematologic disorders and CNS tumours risk estimation. A dose-response analysis will be conducted with consideration to confounding factors such as age at exposure, gender, predisposing factors to cancer and other sources of medical diagnostic low-dose ionising radiation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Indoor pollutants can have short- and long-term health effects, especially if exposure occurs during prenatal life or early childhood. This study describe the perceptions, knowledge, and practices of adults concerning indoor environmental pollution. Adults of 18 to 45 years of age were recruited in the department of Ille-et-Vilaine (Brittany-France) in 2019 through a stratified random draw in the waiting rooms of general practitioners (GPs) ( n = 554) who completed a self-questionnaire. The 71% who had already heard of this type of pollution were older ( p = 0.001), predominantly women ( p = 0.007), not expecting a baby ( p = 0.005), and had a higher knowledge score ( p < 0.001). The average knowledge score was 6.6 ± 6.6 out of 11, which was higher for participants living in a couple and with a higher level of education ( p < 0.001). Some practices were well implemented (>80% of participants) (aeration during renovation) whereas others were insufficiently practiced (<60% of participants) (paying attention to the composition of cosmetic products). Factors associated differed depending on the frequency of integration: living in a couple and having a child for well implemented practices and educational level, knowledge level, and perception for those under implemented. Knowledge must be improved to modify perceptions and certain practices, making sure not to increase social inequalities in health., Competing Interests: The authors declare no conflicts of interest.

On 27 December 2019, the French Public Health Agency identified a large increase in the number of acute gastroenteritis and vomiting visits, both in emergency departments and in emergency general practitioners' associations providing house-calls. In parallel, on 26 and 27 December, an unusual number of food-borne events suspected to be linked to the consumption of raw shellfish were reported through the mandatory reporting surveillance system. This paper describes these concomitant outbreaks and the investigations' results.

Background: Unlike previous randomized clinical trials (RCTs), recent trials and meta-analyses have shown that transcatheter closure of patent foramen ovale (PFO) reduces stroke recurrence risk in young and middle-aged adults with an otherwise unexplained PFO-associated ischaemic stroke., Aim: To produce an expert consensus on the role of transcatheter PFO closure and antithrombotic drugs for secondary stroke prevention in patients with PFO-associated ischaemic stroke., Methods: Five neurologists and five cardiologists with extensive experience in the relevant field were nominated by the French Neurovascular Society and the French Society of Cardiology to make recommendations based on evidence from RCTs and meta-analyses., Results: The experts recommend that any decision concerning treatment of patients with PFO-associated ischaemic stroke should be taken after neurological and cardiological evaluation, bringing together the necessary neurovascular, echocardiography and interventional cardiology expertise. Transcatheter PFO closure is recommended in patients fulfilling all the following criteria: age 16-60 years; recent (≤6 months) ischaemic stroke; PFO associated with atrial septal aneurysm (>10mm) or with a right-to-left shunt>20 microbubbles or with a diameter≥2mm; PFO felt to be the most likely cause of stroke after thorough aetiological evaluation by a stroke specialist. Long-term oral anticoagulation may be considered in the event of contraindication to or patient refusal of PFO closure, in the absence of a high bleeding risk. After PFO closure, dual anti-platelet therapy with aspirin (75mg/day) and clopidogrel (75mg/day) is recommended for 3 months, followed by monotherapy with aspirin or clopidogrel for≥5 years., Conclusions: Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists., (Copyright © 2019.)

Objectives: The aim of this study was to describe and analyze data from patients treated in France with the Edwards SAPIEN transcatheter heart valve (Edwards Lifesciences LLC, Irvine, California) in the pulmonary position., Background: The Edwards SAPIEN valve has recently been introduced for percutaneous pulmonary valve implantation (PPVI)., Methods: From April 2011 to May 2017, 71 patients undergoing PPVI were consecutively included., Results: The median age at PPVI was 26.8 years (range 12.8 to 70.1 years). Primary underlying diagnoses were conotruncal malformations (common arterial trunk, tetralogy of Fallot and variants; n = 45), Ross procedure (n = 18), and other diagnoses (n = 8). PPVI indication was pure stenosis in 33.8% of patients, pure regurgitation in 28.1%, and mixed lesions in 38.1%. PPVI was successfully implemented in 68 patients (95.8%). Pre-stenting of the right ventricular outflow tract was performed in 70 patients (98.6%). Early major complications occurred in 4 subjects (5.6%), including 1 death, 1 coronary compression, and 2 pulmonary valve embolizations. Three of the 4 major complications occurred in the first 15 operated patients. No significant regurgitation was recorded after the procedure. Transpulmonary gradient was significantly reduced from 34.5 to 10.5 mm Hg (p < 0.0001). No patient died during a 1-month follow-up period. At 1-year follow-up, the death rate was 2.9%, and 3 patients had undergone surgical reintervention (44%)., Conclusions: Early results with the Edwards SAPIEN valve in the pulmonary position demonstrate an ongoing high rate of procedural success., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Many stents are used "off-label" during the management of congenital heart diseases (CHD)., Aims: To describe indications for, results of, and adverse events associated with stenting in CHD in current practice., Methods: Participation in this study was proposed to all catheterization laboratories that specialize in CHD in France (M3C network). All paediatric and adult CHD cases with stent implantation in 2013 were included retrospectively., Results: Overall, 207 stents were implanted in 151 patients across 11 centres. Median age was 13.7 years (range, 5 days to 70.1 years). Main procedure indications were branch pulmonary artery angioplasty (n=46, 29.1%), aortic (re)coarctation stenting (n=43, 27.2%), percutaneous pulmonary valve implantation (n=32, 20.2%) and ductus arteriosus stenting (n=14, 8.9%). The main stents implanted were the CP Stent™ (n=61, 29.5%), the Max™ LD stent (n=43, 20.8%), the Valeo(®) stent (n=28, 13.5%) and valved stents (n=30, 14.5%). Procedures were considered successful in 96.8% of cases (95% confidence interval [CI] 92.8-99.0%). Adverse events were observed in 23 procedures (14.7%, 95% CI 9.5-21.0%). Ductus arteriosus stenting (odds ratio 12.4, 95% CI 2.0-77.5; P<0.01) and pulmonary revalvulation (odds ratio 5.9, 95% CI 1.1-32.3; P=0.04) were risk markers for stent-related adverse events., Conclusions: Stents are used in various CHD catheterization procedures, from infancy to adult age. The adverse events rate is significant and is related to the type of procedure., (Copyright © 2015. Published by Elsevier Masson SAS.)

The creation of intracaval conduits to repair partial anomalous pulmonary venous connection of the right lung into the superior vena cava can be complicated by arrhythmias and superior vena cava and pulmonary vein obstruction. An intra-atrial baffle, combined with cavo-atrial anastomosis, has been proposed to avoid these complications. The authors report their recent experience with this operative technique. From January 1997 to December 2000, 7 patients with a mean age of 13.5 +/- 9 (2-31) years were operated according to this technique. Only one child did not have an associated atrial septal defect. The mean number of pulmonary veins connected to the superior vena cava was 2.5 +/- 0.5. The immediate postoperative course was uneventful for the seven patients. The mean follow-up was 20 +/- 17 months. No patient developed arrhythmia or superior vena cava or pulmonary vein obstruction at echocardiography. This surgical technique appears to constitute an attractive alternative when pulmonary veins drain abnormally into the superior vena cava above the cavo-atrial junction.