1. Indications for surgery Because of the severe changes in the condition of TAPVC, pulmonary hypertension and acute congestive right heart failure are likely to occur, and the mortality rate without intervention is about 80% in the first year of life. Once the diagnosis is clear, surgery should be performed immediately, including patients with stable hemodynamics and low metabolic disorders should also be operated as soon as possible. If there is pulmonary venous obstruction, and the hemodynamic changes are large, the patient’s condition is critical, then emergency surgery should be performed. 2.Pre-operative preparation Patients with non-obstructed pulmonary venous return and non-restricted ASD usually need only general pre-operative preparation because their condition is stable and satisfactory. For patients with concomitant severe pulmonary hypertension, surgery is scheduled early once the diagnosis is clear. If complicated by pulmonary infection or chronic cardiac insufficiency, antibiotics or digoxin and diuretics can be used to further control pulmonary inflammation and improve cardiac function, and surgery can be performed after controlling pulmonary infection as much as possible. Patients with pulmonary venous obstruction may have progressive hypoxia, hypoperfusion of the body circulation, and progressive hemodynamic failure, requiring emergency surgical treatment. These patients usually require intubation for mechanical assisted ventilation with appropriate oxygen, which reduces pulmonary vascular resistance and maximizes oxygen transport. Prostaglandin medications are applied to keep the arterial catheter open, which can serve as a protective right-to-left shunt. Positive inotropic drug support may improve right ventricular dilation and dysfunction, and acid correction should be used to improve sensitivity to catecholamines. Severe pulmonary infections, right heart insufficiency, even intubated assisted breathing, antibiotic treatment of pulmonary inflammation not fully controlled, and chronic cardiac insufficiency not improving with medication may also lead to emergency surgery as long as the temperature returns to normal or near normal and there are no wet rales in the lungs, otherwise the child may be lost to surgery. If these measures still fail to improve oxygenation and perfusion of the body circulation, preoperative ECMO support should be considered. In patients with severe preoperative metabolic disturbances that cannot be corrected, preoperative phased use of ECMO can be very useful. Short-term use of ECMO for 1-2 days can correct and stabilize end-organ dysfunction and improve the prognosis of such critically ill infants. At the end of surgery the patient’s pulmonary hypertension is corrected, he or she can be taken off cardiopulmonary diversion, and the ECMO cannula is removed. Of course, the use of ECMO postoperatively is also beneficial. Because of the concomitant hypoxemia and metabolic acidosis, anesthesia needs to be handled with care. Pure oxygen hyperventilation is given to reduce pulmonary vascular resistance and high-dose fentanyl is applied to induce anesthesia, which reduces pulmonary vascular reactivity. If positive inotropic drugs are required, isoprenaline can be used as long as the child is not tachycardic. Given the characteristics of mild left heart dysplasia, it is often necessary to maintain the heart rate above 200 beats/min in order to maintain adequate cardiac output, and acid replacement should also be actively treated.