<International Circulation>:  Surgical correction of the sinus venosus syndrome has been associated with sinus node dysfunction and venous obstruction postoperatively. Based on your experiences， how can you prevent these complications?

   Dr Uemura:  We need to be familiar with the structure and anatomy in great detail， so morphologic recognition is the starting point. The surgical technique and skills of the surgeon of course are very important in avoiding problems.

    <International Circulation>: There are maybe some risk factors related to adverse outcomes of surgical repair for sinus venosus and primum atrial septal defects. Can you summarize these for us?

   Dr Uemura:  When the surgical indication is correct， usually the surgical result is very good. These days we do not have any operative deaths. Age is an important indication to think about， because the age reflects the history of the abnormal circulation. If we have a 40 or 50 year old patient， there will be 40 or 50 years of abnormal circulation which cumulatively adds to the risk factors. One of these is pulmonary hypertension and the other is left ventricular function. When we are young， the ventricles are very healthy and active and as we age， even in those with normal hearts， our ventricles get tired. In systemic hypertension， the left ventricle gets stiffer and increases the flow across the atrial septal defect and will manifest as clinical symptoms. So it is the disease of the left ventricle which emerges as a risk factor. Other factors such as atrial fibrillation， is a disease associated with age， so should be taken into account with age as a risk factor.