Primary sutureless repair for “simple” total anomalous pulmonary venous connection: Midterm results in a single institution

Use of high-frequency ventilation to wean off cardiopulmonary bypass in a patient with pulmonary hemorrhage after failure of conventional ventilation

The management of an infant who underwent corrective surgery for a supracardiac total anomalous pulmonary venous drainage, which was complicated by the development of pulmonary hemorrhage while separating from cardiopulmonary bypass, is presented. Initiation of high-frequency oscillatory ventilation was effective in weaning the patient off cardiopulmonary bypass.

Modified Primary Sutureless Repair Technique of Total Anomalous Pulmonary Venous Connection

Surgical correction of total anomalous pulmonary venous connection is associated with an important risk of postrepair pulmonary vein obstruction. Primary sutureless anastomosis at the time of initial surgical repair might mitigate that risk. A simplified primary sutureless technique is described in this report.

Modified transseptal repair for total anomalous pulmonary venous connection repair in all age groups

Little data are available in late-presenting children with unobstructed totally anomalous pulmonary venous connection. Eleven patients underwent repair at a median age of 6.5 months using a modified transseptal approach to improve access and avoid circulatory arrest. There were no early or late deaths, and none of the patients presented pulmonary venous stenosis at a median follow-up of 8.7 years.

Midterm outcomes of sutureless technique for postoperative pulmonary venous stenosis

BACKGROUND

The efficacy of a sutureless technique for postoperative pulmonary venous stenosis (PVS) following repair of total anomalous pulmonary venous connection (TAPVC) has been reported, though detailed clinical advantages remain unclear. We retrospectively reviewed our surgical experience, and compared outcomes between conventional procedures and a sutureless technique.

METHODS

For relief of postoperative PVS after TAPVC repair, five patients underwent a conventional procedure, such as orifice cutback or resection of a proliferated intima, from 1999 to 2004 (Conventional group, 4 males, median 93 days old, 3.6 kg), then seven underwent a sutureless technique (Sutureless group, 5 males, 119 days old, 3.4 kg) from 2005 to 2011. Patients with a functional single ventricle were excluded. There were no significant differences regarding patient characteristics. Follow-up examinations were completed in all patients.

RESULTS

The rate for cumulative survival at 5 years was 60 % in the Conventional group and 71.4 % in the Sutureless group. Re-stenosis after relief of PVS occurred in 100 % (10/10) of patients in the Conventional group and 31.6 % (6/19) of patients in the Sutureless group (p = 0.0088). For bilateral venous stenosis patients, the survival rate was 66.7 % (4/6) in the Sutureless group and 0 % (0/2) in the Conventional group (p = 0.10). Out of three patients who developed whole 4-vein stenosis, only one in the Sutureless group survived.

CONCLUSIONS

Although overall survival rate was similar in both groups, the Sutureless technique for postoperative PVS following TAPVC repair successfully rescued more pulmonary veins without re-stenosis than conventional procedures. Further follow-up may demonstrate therapeutic advantages.

Primary sutureless repair for simple total anomalous pulmonary venous connection with a risk of postoperative pulmonary venous stenosis

Late mortality following surgical repair of total anomalous pulmonary venous connection (TAPVC) is often associated with pulmonary venous stenosis. We describe here two successful cases of primary sutureless repair for simple TAPVC in patients who had a potential risk of postoperative pulmonary venous stenosis. A 10-day-old neonate with mixed-type TAPVC and a 30-day-old infant with supracardiac TAPVC underwent primary sutureless repair with our modification. In the early follow-up, both patients are now doing well and have no signs of pulmonary venous stenosis. The sutureless repair can be applied as a primary surgical option to prevent postoperative pulmonary venous stenosis in selective patients with simple TAPVC.