Echocardiography is an important part of the evaluation and may identify the anomalous particularly in patients with excel- lent acoustic windows; however, CMR and CTA are superior for evaluating extracardiac vascular anatomy. 2. In higher-risk patients, invasive hemodynamic assessment can be useful for direct measurement of pressures, quantification of shunt magnitude, and measurement of pulmonary arterial resist- ance and responsiveness to pulmonary vasodi- lator therapy. Invasive hemodynamic assessment is especially important in adult patients who are being considered for surgical correction. 3. It is unusual for a single anomalous pulmonary venous connection of only 1 pulmonary lobe to result in a sufficient volume load to justify sur- gical repair. However, if a patient has symptoms referable to the shunt, there is >1 anomalous vein, and a moderate or large left-to-right shunt, then surgical repair is associated with a reduc- tion in RV size and PA pressure.S4.1.2-5 Pulmonary hypertension is a risk for adverse outcomes with surgery. 4. Surgery usually involves intracaval baffling into the left atrium, Warden procedure,S4.1.2-12 or direct reimplantation of the anomalous pulmonary vein directly into the left atrium. 5. Surgical repair of a scimitar vein includes direct reimplantation of the scimitar vein into the left atrium, conduit placement to the left atrium, or intracaval baffling. This surgery can be technically challenging with a greater risk of postoperative vein thrombosis than is associated with more common and simpler anomalous pulmonary vein Pulmonary hypertension is associated with poor outcomes. 6. It is unusual for a single anomalous pulmonary venous connection from only one pulmonary lobe to result in a sufficient volume load to justify sur- gical repair. 