Partial bilateral anomalous pulmonary venous connections are one of the rare forms of congenital heart diseases which can cause some difficulties and problems during the preoperative diagnostic procedures.

In our clinic, we have diagnosed peroperatively and treated successfully by left thoracotomy and without extracorporeal circulation such kind of a case which we could not find anatomically and exact same one in the literature. This patient wes previously operated for ASD secundum and the detect was closed by a pacth.

During the echocardiographic, angiographic and peroperative evaluations of the patients wit congenital left-to-right shunts, coexistance of an anomalous pulmonary venous connection must always be remembered. In our case, except the right inferior pulmonary vein, all pulmonary veins had been connected to a common pulmonary venous sinus, and than to the innominate vein via an abnormal vertical vein. Since the atrial septal defect was previously repaired by a patch, the patient was reoperated by left anterolateral thoracotomy from the 4th intercostal space. The pathology was totally correted by anastomosing the left atrial appendage to the corpus of the comon pumonary sinus under the side clamps, and by ligating the abnormal vertical vein just before its entrance to the innominate vein. Blood gas samples taken from the right atrium and the pulmonary artery revealed no evidence of shunt. Remarkable functional improvement was postoperatively observed.

The paient tlerated the second surgial procedure well and her postoperative course was uncomplicated. The patient was discharged from the hospital 15 days after the second operation.