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Figure 1 Diagrams of the pulmonary venous atrium following Mustard (a–c) and Senning (d) operations as viewed from a right anterior oblique projection. They illustrate the variations of surgical handling of the coronary sinus and medial isthmus between the inferior vena cava orifice and the tricuspid valve. (a) Inferior atrial baffle suture line is placed posterior to the coronary sinus ostium, keeping it and nearly all of the medial isthmus on the pulmonary venous side (Patients 2, 10). (b) Suture line is in approximately the same location as in (a), but the ostium is surgically redirected posteriorly into the systemic venous atrium (Patients 1, 3, 6, 8). (c) Suture line is placed anterior to the coronary sinus ostium, keeping it and a large portion of the medial isthmus on the systemic venous side (Patients 4, 5). (d) Right atrial freewall edge (arrows), which serves as a roof over the systemic venous tube, is sutured posterior to the coronary sinus ostium, similar in location to (a) (Patients 9, 11). AVN = compact AV node; CSO = coronary sinus ostium; TV = septal leaflet of tricuspid valve; cross-hatched area = medial isthmus; shaded area = region of "slow" inputs into AV node; stippled area = region of "fast" inputs into AV node.
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