101
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Shim H, Yang JH, Jun TG. Two-stage correction of type IV total anomalous pulmonary venous connection. J Cardiothorac Surg 2017; 12:54. [PMID: 28683753 PMCID: PMC5501404 DOI: 10.1186/s13019-017-0617-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/21/2017] [Indexed: 11/24/2022] Open
Abstract
Background The small size of the pulmonary veins in infants increases the risk of pulmonary vein obstruction (PVO) after surgical repair of type IV total anomalous pulmonary venous connection (TAPVC). Here, we described the outcomes of our strategy, which delayed total correction after initial partial correction. Methods We reviewed the data of patients who underwent total correction for type IV TAPVC. In total, 11 out of 103 patients with TAPVC had type IV TAPVC with biventricular physiology. Of these 11 patients, we retrospectively reviewed the data of 7 patients who underwent two-stage correction. Major pulmonary venous confluent chambers, with the exception of the left superior pulmonary vein (LSPV), were initially anastomosed to the left atrium (LA), followed by anastomosis between the LSPV and the LA auricle. Results The median weight, age, and LSPV size were 4.3 kg (range, 3.5–5.4 kg), 40 days (range, 20–103 days), and 4.5 mm (range, 3.0–5.4 mm), respectively, during the first operation and 12.2 kg (range, 8.5–31.5 kg), 1,165 days (range, 280–3,250 days), and 9.8 mm (range, 8.0–12.3 mm), respectively, during the second operation. The median Qp/Qs was 1.61 (range, 1.22–1.65) and the median cardiothoracic ratio was 0.52 (range, 0.49–0.57) at second operation. The median interval between the operations was 1,094 days (range, 196–3,226 days). The median follow-up period was 22 month (range, 7–59 month). No mortality or major morbidities occurred after either operation. The median Vmax at the LSPV anastomosis site was 1.0 m/s (range, 0.8–1.3 m/s) on predischarge echocardiography. This patency was maintained at the last follow-up, showing an identical median Vmax of 1.0 m/s (range, 0.8–1.3 m/s). All 7 patients who underwent two-stage correction were in good condition, without any clinical symptoms of PVO. Conclusions Our results suggest that leaving the isolated LSPV uncorrected during infancy and performing a second operation when the LSPV has grown adequately is a viable treatment option for patients with type IV TAPVC.
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Affiliation(s)
- Hunbo Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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102
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McDermott J, Study D, Clayton-Smith J. Sibling recurrence of total anomalous pulmonary venous drainage. Eur J Med Genet 2017; 60:265-267. [DOI: 10.1016/j.ejmg.2017.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/17/2017] [Accepted: 03/05/2017] [Indexed: 11/25/2022]
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103
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Yoshimura N, Fukahara K, Yamashita A, Doi T, Takeuchi K, Yamashita S, Homma T, Yokoyama S, Aoki M, Ikeno Y. Surgery for total anomalous pulmonary venous connection: primary sutureless repair vs. conventional repair. Gen Thorac Cardiovasc Surg 2017; 65:245-251. [DOI: 10.1007/s11748-017-0769-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/05/2017] [Indexed: 11/30/2022]
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104
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Türkvatan A, Güzeltaş A, Tola HT, Ergül Y. Multidetector Computed Tomographic Angiography Imaging of Congenital Pulmonary Venous Anomalies: A Pictorial Review. Can Assoc Radiol J 2017; 68:66-76. [DOI: 10.1016/j.carj.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/28/2015] [Accepted: 05/06/2016] [Indexed: 11/28/2022] Open
Abstract
Congenital pulmonary venous anomalies are not uncommon that can occur either in isolation or in association with different forms of congenital heart disease. Clinical presentation of these anomalies may vary from the relatively benign single anomalous partial pulmonary venous return to life-threatening critical obstructed total anomalous pulmonary venous return. Accurate delineation of these anomalies and accompanied cardiovascular anomalies are crucial to guide decision making in these patients. Low-dose high-pitch dual-source 256-detector multidetector computed tomographic angiography is a fast and reliable imaging modality allowing comprehensive noninvasive anatomic imaging in neonates and children with congenital pulmonary venous anomalies with lower radiation doses and should be preferred for these patients after transthoracic echocardiography.
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Affiliation(s)
- Aysel Türkvatan
- Department of Radiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Hasan Tahsin Tola
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Yakup Ergül
- Department of Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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105
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Muntean I, Mărginean C, Stanca R, Togănel R, Pop M, Gozar L. Prenatal diagnoses of an uncommon isolated obstructed supracardiac total anomalous pulmonary venous connection: Case report and review of the literature (CARE compliant). Medicine (Baltimore) 2017; 96:e6061. [PMID: 28151919 PMCID: PMC5293482 DOI: 10.1097/md.0000000000006061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Total anomalous pulmonary venous connection is an uncommon congenital heart disease. Four types are described based on the site of pulmonary venous drainage: supracardiac, cardiac, infradiaphragmathic, and mixed connection. In most cases of supracardiac type, the common venous confluence drains through an ascending left vertical vein into the brachiocephalic vein, right superior vena cava, and then into the right atrium. Anomalous connection of the pulmonary venous confluence directly to the right SVC, especially the obstructed form is an unusual and severe supracardiac variant. The prenatal diagnosis is challenging. PATIENT CONCERNS We present a case report of a fetus diagnosed with TAPVC at 23 gestational weeks. DIAGNOSIS INTERVENTIONS The 4-chamber view showed a small left atrium, with a "smooth" posterior wall and the absence of pulmonary vein connection. This is the first case of prenatally diagnosed isolated, obstructed supracardiac type with drainage directly into the right superior vena cava. CONCLUSION The obstetrician and fetal cardiologist should be cautious at the direct and indirect echocardiographic signs of this condition. A prenatal diagnose of isolated, obstructed form is important for adequate planning of delivery and postnatal surgery in a tertiary center.
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Affiliation(s)
- Iolanda Muntean
- Department of Pediatric Cardiology, University of Medicine and Pharmacy
| | - Claudiu Mărginean
- Department of Obstetric and Gynecology I, University of Medicine and Pharmacy, Tirgu-Mures
| | | | - Rodica Togănel
- Department of Pediatric Cardiology, University of Medicine and Pharmacy
| | - Marian Pop
- County Emergency Hospital, Tîrgu-Mureş, România
| | - Liliana Gozar
- Department of Pediatric Cardiology, University of Medicine and Pharmacy
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106
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Shaw FR, Chen JM. Surgical Considerations in Total Anomalous Pulmonary Venous Connection. Semin Cardiothorac Vasc Anesth 2017; 21:132-137. [PMID: 28107801 DOI: 10.1177/1089253216688535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is predominantly a neonatal congenital cardiac diagnosis in which the pulmonary veins fail to return to the left atrium. The presence or absence of obstruction defines the clinical presentation, and in the setting of obstructed pulmonary veins, this diagnosis represents a true surgical emergency. Improvements in perioperative care and refinement of surgical techniques continue to allow for improved survival and decreased morbidity. A description of the surgical anatomy and key concepts in the perioperative and surgical management of TAPVC are presented in this review.
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Affiliation(s)
- Fawwaz R. Shaw
- West Virginia University School of Medicine, Morgantown, WV, USA
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107
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Shi G, Zhu Z, Chen J, Ou Y, Hong H, Nie Z, Zhang H, Liu X, Zheng J, Sun Q, Liu J, Chen H, Zhuang J. Total Anomalous Pulmonary Venous Connection. Circulation 2017; 135:48-58. [DOI: 10.1161/circulationaha.116.023889] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
Abstract
Background:
Total anomalous pulmonary venous connection (TAPVC) is a rare form of congenital heart disease. This study describes current surgical treatment strategies and experiences in a cohort of patients from 2 congenital cardiac centers in Shanghai and Guangdong in China.
Methods:
This retrospective study included 768 patients operated on between 2005 and 2014. Although most patients (n=690) underwent conventional repair, a sutureless technique was used in 10% (n=78) of cases. A multilevel mixed-effects parametric survival model and a competing-risk analysis were used to analyze associated risk factors for death and recurrent pulmonary venous obstruction (PVO), respectively. Kaplan-Meier analysis was used to analyze the overall survival. The Nelson-Aalen cumulative risk curve was used to compare distributions of time with recurrent PVO.
Results:
The mean surgical age and weight were 214.9±39.2 days and 5.4±3.6 kg, respectively. Obstructed TAPVC (PVO) was documented in 192 (25%) of the 768 patients. There were 38 intraoperative deaths and 13 late deaths. A younger age at the time of repair (
P
=0.001), mixed (
P
=0.004) and infracardiac (
P
=0.035) TAPVC, preoperative PVO (
P
=0.027), prolonged cardiopulmonary bypass time (
P
<0.001), and longer duration of ventilation (
P
=0.028) were associated with mortality. The median follow-up was 23.2 months (range; 1–112 months). Among the 717 survivors, recurrent PVO was observed in 111 patients (15%). Associated risk factors for recurrent PVO included preoperative PVO (
P
<0.001), infracardiac TAPVC (
P
<0.001), mixed TAPVC (
P
=0.013), and prolonged cardiopulmonary bypass time (
P
<0.001). Sutureless technique was associated with a lower restenosis rate compared with conventional repair in patients with preoperative PVO (
P
=0.038), except in newborn patients (
P
=0.443). Reintervention for restenosis was performed in 24 patients. The function of most survivors (91%) was classified according to the New York Heart Association as functional class I or II.
Conclusions:
Surgical correction in patients with TAPVC with a biventricular anatomy can achieve an acceptable outcome. Risk factors such as a younger age at the time of repair, infracardiac and mixed TAPVC, and preoperative PVO were associated with a poorer prognosis.
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Affiliation(s)
- Guocheng Shi
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Zhongqun Zhu
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Jimei Chen
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Yanqiu Ou
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Haifa Hong
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Zhiqiang Nie
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Haibo Zhang
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Xiaoqing Liu
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Jinghao Zheng
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Qi Sun
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Jinfen Liu
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Huiwen Chen
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
| | - Jian Zhuang
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China
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108
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Yong MS, Yaftian N, Weintraub RG, Brizard CP, d'Udekem Y, Konstantinov IE. Outcomes of Surgery for Mixed Total Anomalous Pulmonary Venous Drainage in Children. Semin Thorac Cardiovasc Surg 2017; 29:338-344. [DOI: 10.1053/j.semtcvs.2017.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2017] [Indexed: 11/11/2022]
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109
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Făgărășan A, Muntean I, Gozar L, Pasc S, Togănel R. Total Anomalous Pulmonary Venous Connection in Children. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: The aim of this study was to study the anatomical types of total anomalous pulmonary venous connection (TAPVC), the associated cardiac and extracardiac congenital malformations, clinical manifestations, and postoperative evolution.
Materials and methods: Twenty-four patients with a mean age of 125 days, admitted to the Clinic of Pediatric Cardiology III between January 1, 2009 and December 31, 2015 and diagnosed with TAPVC were included in the study. The patients were evaluated clinically, electrocardiographically and echocardiographically, both pre- and postoperatively. Postoperative evolution was monitored at 1, 3, 6, 12 and 24 months.
Results: The anatomical types of TAPVC were: supracardiac in 50% of cases (12 patients), cardiac in 37.5% (9 patients) and mixed type in 12.5% of cases (3 patients). The first clinical manifestation was cyanosis in 72.2% of cases. Surgical correction was performed at a mean age of 37 days in obstructive forms, and 254 days in non-obstructive forms. From the study lot, 8.4% of patients had associated extracardiac malformations (anorectal agenesis and Ivemark syndrome). Early postoperative complications included pulmonary hypertension crisis (60% of cases), supraventricular arrhythmias (35% of cases) and chylothorax (8.4% of cases). Late postoperative complications included: reintervention in 8% of patients with mixed type TAPVC.
Conclusions: The most frequently encountered type was supracardiac TAPVC, which had a favorable postoperative evolution. Mixed type TAPVC had the highest rate of reintervention.
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Affiliation(s)
| | | | - Liliana Gozar
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Sorina Pasc
- Clinic of Pediatric Cardiology III, Institute of Cardiovascular Diseases and Emergency Transplant, Tîrgu Mureș, Romania
| | - Rodica Togănel
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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110
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Files MD, Morray B. Total Anomalous Pulmonary Venous Connection: Preoperative Anatomy, Physiology, Imaging, and Interventional Management of Postoperative Pulmonary Venous Obstruction. Semin Cardiothorac Vasc Anesth 2016; 21:123-131. [PMID: 27831520 DOI: 10.1177/1089253216672442] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Total anomalous pulmonary venous connection refers to a spectrum of cardiac anomalies where the pulmonary veins fail to return to the left atrium and the pulmonary venous blood returns through a systemic vein or directly to the right atrium. There is a wide anatomical variety of venous connections and degrees of pulmonary venous obstruction that affect the presentation, surgical repair, and outcomes. In this review, we explore the preoperative physiology, echocardiographic diagnosis, and approach to postoperative complications.
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111
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Figueras-Coll M, Sabaté-Rotés A, Cañete-Abajo N, Abella RF. A singular case of non-obstructive supracardiac total anomalous pulmonary venous connection with two vertical veins in a 30weeks preterm neonate. Int J Cardiol 2016; 223:50-51. [PMID: 27529591 DOI: 10.1016/j.ijcard.2016.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Marc Figueras-Coll
- Pediatric Cardiology Department, Universitat de Girona, Hospital Universitari Doctor Josep Trueta, Girona, Spain.
| | - Anna Sabaté-Rotés
- Pediatric Cardiology Department, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Noemí Cañete-Abajo
- Radiology Department, Universitat de Girona, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Raúl Felipe Abella
- Pediatric Cardiac Surgery Department, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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112
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Zhang Z, Zhang L, Xie F, Wang B, Sun Z, Kong S, Wang X, Dong N, Wang G, Lv Q, Li Y, Li L, Xie M. Echocardiographic diagnosis of anomalous pulmonary venous connections: Experience of 84 cases from 1 medical center. Medicine (Baltimore) 2016; 95:e5389. [PMID: 27858923 PMCID: PMC5591171 DOI: 10.1097/md.0000000000005389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We sought to evaluate the value of echocardiography in the diagnosis of different types of anomalous pulmonary venous connections (APVCs) and summarize the diagnostic experience. A total of 84 patients with APVC were confirmed by surgery (n = 82) or computerized tomography angiography (CTA) (n = 2) in the last 6 years (2008-2014) at the Wuhan Union Hospital. The total anomalous pulmonary venous connection (TAPVC) cases account for 60.7%, and partial anomalous pulmonary venous connection (PAPVC) cases account for 39.3% among the 84 cases that were identified. The 51 TAPVCs were classified by the Darling method-type I (41.1%), type II (52.9%), type III (1.9%), and type IV (3.9%). The most common drainage path of type I was common pulmonary drainage to the left innominate vein via vertical vein, and the coronary sinus drainage was the most common path in type II. Compared with surgical or CTA results, the sensitivity and specificity of echocardiography in the diagnosis of APVCs were 97.6% and 99.9%, respectively. The echocardiography misdiagnoses were mainly seen in PAPVCs. Of the TAPVCs and PAPVCs correctly diagnosed by echocardiography, the diagnostic accuracy of classification were 94% and 100%, respectively. Echocardiography has specific value in diagnosing and classification of APVC, especially the supracardiac and cardiac TAPVCs. Multiplane scan views and color Doppler improve the display of drainage pathway.
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Affiliation(s)
- Ziming Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Xie
- Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Bing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhengxing Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuangshuang Kong
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinfang Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guohua Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Mingxing Xie, Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China (e-mail: ); Ling Li, Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China (e-mail: )
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Mingxing Xie, Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China (e-mail: ); Ling Li, Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China (e-mail: )
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113
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Ross FJ, Joffe D, Latham GJ. Perioperative and Anesthetic Considerations in Total Anomalous Pulmonary Venous Connection. Semin Cardiothorac Vasc Anesth 2016; 21:138-144. [PMID: 27694572 DOI: 10.1177/1089253216672012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a potentially devastating form of congenital heart disease in which all pulmonary blood flow returns to the systemic venous circulation rather than the left atrium. Anomalous pulmonary venous flow may be obstructed at birth, and affected infants present with severe cyanosis and poor cardiac output unresponsive to standard resuscitation with prostaglandin. Obstructed TAPVC remains one of the few indications for emergent neonatal cardiac surgery. This review will discuss the physiology and perioperative management of isolated TAPVC without associated cardiac lesions.
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Affiliation(s)
- Faith J Ross
- 1 Seattle Children's Hospital, Seattle, WA, USA.,2 University of Washington School of Medicine, Seattle, WA, USA
| | - Denise Joffe
- 1 Seattle Children's Hospital, Seattle, WA, USA.,2 University of Washington School of Medicine, Seattle, WA, USA
| | - Gregory J Latham
- 1 Seattle Children's Hospital, Seattle, WA, USA.,2 University of Washington School of Medicine, Seattle, WA, USA
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114
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Respondek-Liberska M, Sokołowski Ł, Słodki M, Zych-Krekora K, Strzelecka I, Krekora M, Maroszyńska I, Moll J, Moll J. Prenatal Diagnosis of TAPVC on Monday, Delivery of Tuesday and Cardiac Surgery at Wednesday - A Model of Perinatal Care in 3rd Trimester in Case of Fetal/Neonatal Critical Heart Defect in Tertiary Center. PRENATAL CARDIOLOGY 2016. [DOI: 10.1515/pcard-2016-0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect (CHD), in which all pulmonary veins connect to the systemic veins or to the right atrium/coronary sinus instead of the left atrium. We present a case report of fetus with prenatally diagnosed isolated infracardiac type of TAPVC in 38th week of gestation. In fetal echocardiographic examination performed in the Department of Prenatal Cardiology, the fetus presented lack of visible pulmonary veins connection to left atrium, abnormal venous confluence behind left atrium, additional vein leading from abdominal cavity to mediastinum and abnormal smooth Doppler blood flow in pulmonary confluence. The accurate prenatal diagnosis allowed to deliver the neonate at term, in tertiary center one day after diagnosis, and to perform surgical reposition of pulmonary veins the following day. The neonate was referred home in a good condition after 28 days of hospitalization. This case is a good example of the value of the 3rd trimester echocardiography.
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Affiliation(s)
- Maria Respondek-Liberska
- 1. Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute
- 2. Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations Lodz, Poland
| | - Łukasz Sokołowski
- 3. Medical University of Lodz, Students Research Circle Prenatal Cardiology
| | - Maciej Słodki
- 1. Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute
- 4. Institute of Health Sciences, The State School of Higher Professional Education in Płock, Poland
| | - Katarzyna Zych-Krekora
- 2. Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations Lodz, Poland
| | - Iwona Strzelecka
- 2. Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations Lodz, Poland
- 5. Department of Nursing, Medical
| | - Michał Krekora
- 6. University of Lodz Department of Obstetrics & Gynecology Research Institute of Lodz
| | - Iwona Maroszyńska
- 7. Department of Intensive Care of Neonates and Congenital Malformations, Research Institute Polish Mother's Memorial Hospital
| | - Jadwiga Moll
- 8. Department of Pediatric Cardiology, Research Institute Polish Mother's Memorial Hospital
| | - Jacek Moll
- 9. Department of Pediatric Cardiac Surgery, Research Instiute Polish Mother's Memorial Hospital
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Abstract
In this study, we present the case of a neonate with obstructed infracardiac total anomalous pulmonary venous connection with severe pulmonary hypertension and a patent ductus arteriosus with right-to-left shunting. The patient had an unusual finding of pandiastolic flow reversal in the upper descending thoracic aorta. He underwent emergency surgical re-routing of the pulmonary veins to the left atrium, and postoperative echocardiography showed disappearance of the descending aortic flow reversal. We hypothesise that in severely obstructed total anomalous pulmonary venous connection the left ventricular output may be extremely low, resulting in flow reversal in the descending aorta.
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116
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Pulmonary vein stenosis: Severity and location predict survival after surgical repair. J Thorac Cardiovasc Surg 2016; 151:657-666.e2. [DOI: 10.1016/j.jtcvs.2015.08.121] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/25/2015] [Accepted: 08/29/2015] [Indexed: 11/22/2022]
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117
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Bernal Garnes N, Méndez Díaz C, Soler Fernández R, Rodríguez García E. Resonancia magnética en la valoración de las conexiones venosas pulmonares anómalas. RADIOLOGIA 2016; 58:111-9. [DOI: 10.1016/j.rx.2015.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/10/2015] [Accepted: 07/20/2015] [Indexed: 11/28/2022]
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118
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Positional Relationship Between the Pulmonary Venous Confluence-Vertical Vein and Atria in Infracardiac Total Anomalous Pulmonary Venous Connection. Pediatr Cardiol 2016; 37:372-7. [PMID: 26481116 DOI: 10.1007/s00246-015-1286-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
To explore the positional relationship between the pulmonary venous confluence-venous vein (PVC-VV) and both the atria in infracardiac total anomalous pulmonary venous connection (iTAPVC), using two-dimensional (2D) computerized tomography (CT) reconstruction. Through the 2D reconstruction of enhanced cardiac CT images of patients with iTAPVC, the projection of PVC-VV on coronal axial images was acquired and its location on the bilateral atrial splice was analyzed. Sagittal axial reconstruction was used to identify which atrium had a precise anterior-posterior positional relationship with PVC-VV. The type of iTAPVC, where the projection of PVC-VV was lying on the left atrium, and the left atrium had a precise anterior-posterior positional relationship with PVC-VV, was classified as the left atrial type. If the projection of PVC-VV was lying on the right atrium and the right atrium had a precise anterior-posterior positional relationship with PVC-VV, it was classified as the right atrial type. Finally, if the projection of PVC-VV was lying in the middle of the bilateral atria, and both the atria had precise anterior-posterior positional relationship with PVC-VV, it was referred to as the bilateral atrial type. Upon analysis of the 22 enhanced cardiac CT images, 6 were the left atrial type (27.27 %), 9 were right atrial type (40.91 %), while 7 were of the bilateral atrial type (31.82 %). The positional relationship between PVC-VV and the bilateral atria are variable, and iTAPVC classification using 2D CT reconstruction is an invaluable tool in designing the surgical approaches in iTAPVC.
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119
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Fuchigami T, Nishioka M, Akashige T, Nabeshima T, Nagata N. Total anomalous pulmonary venous connection with ventricular septal defects. Asian Cardiovasc Thorac Ann 2015; 25:62-64. [PMID: 26645702 DOI: 10.1177/0218492315622102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The association of total anomalous pulmonary venous connection with ventricular septal defect and aortic coarctation is rare. A premature neonate weighing 1350 g was diagnosed with infracardiac total anomalous pulmonary venous connection, aortic coarctation, and a perimembranous ventricular septal defect. On postnatal day 23, we performed emergency extended aortic arch anastomosis under total circulatory arrest, pulmonary venous connection repair using a primary sutureless technique, and patch closure of the atrial septal and perimembranous ventricular septal defects. The patient was discharged without complications. Postoperative echocardiography showed no residual coarctation or pulmonary venous obstruction and revealed small muscular ventricular septal defects.
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Affiliation(s)
- Tai Fuchigami
- 1 Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Haebaru-cho, Okinawa, Japan
| | - Masahiko Nishioka
- 1 Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Haebaru-cho, Okinawa, Japan
| | - Toru Akashige
- 1 Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Haebaru-cho, Okinawa, Japan
| | - Taisuke Nabeshima
- 2 Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Haebaru-cho, Okinawa, Japan
| | - Nobuhiro Nagata
- 1 Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Haebaru-cho, Okinawa, Japan
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120
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Mixed Supra- and Intracardiac Totally Anomalous Pulmonary Venous Connection in an Adult Female: Pre- and Postoperative Evaluation with Emphasis on MDCT Angiographic Advantages. Heart Lung Circ 2015; 24:e188-92. [DOI: 10.1016/j.hlc.2015.06.822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 11/17/2022]
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121
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Repair Type Influences Mode of Pulmonary Vein Stenosis in Total Anomalous Pulmonary Venous Drainage. Ann Thorac Surg 2015; 100:654-62. [DOI: 10.1016/j.athoracsur.2015.04.121] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
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122
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Hazelzet T, Durand I, David N. [Total isolated anomalous pulmonary venous return: Are there any clues for prenatal screening?]. ACTA ACUST UNITED AC 2015; 43:541-8. [PMID: 26139032 DOI: 10.1016/j.gyobfe.2015.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a serious congenital anomaly. TAPVC with obstruction of pulmonary venous return is an emergency requiring urgent intervention. Before 2010, very few isolated TAPVC were diagnosed prenatally. It has been suggested in the past literature that the use of Color flow Doppler is particularly useful for the screening of TAPVC prenatally. In fact, although color-Doppler is often useful to confirm a TAPVC diagnosis, it can be quite misleading in the screening process of the condition. Looking at data of missed TAPVC, we describe how to identify TAPVC during routine cardiac screening. Since 2010, our isolated TAPVC prenatal diagnosis rate is more than 40%.
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Affiliation(s)
- T Hazelzet
- Unité de cardiopédiatrie, Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France.
| | - I Durand
- Unité de cardiopédiatrie, Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - N David
- Unité de cardiopédiatrie, Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
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123
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Gan C, Ji P, Lin K, Feng Y. A Novel Hybrid Approach for Balloon Dilation of Pulmonary Vein Stenosis Following Total Anomalous Pulmonary Venous Connection Repair with Atrial Septal Patching. J Card Surg 2015; 30:608-10. [PMID: 25973524 DOI: 10.1111/jocs.12571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pulmonary venous obstruction after the repair of total anomalous pulmonary venous connection is a serious complication. Transcatheter interventional treatment is a palliative choice to defer the timing of surgery; however, penetrating through the patched atrial septum may be difficult. We report a technique for pulmonary venous obstruction after mixed-type total anomalous pulmonary venous connection repair using balloon dilatation of the pulmonary veins through a novel hybrid approach.
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Affiliation(s)
- Changping Gan
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Peng Ji
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Ke Lin
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
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124
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Neurocognitive outcomes at kindergarten entry after surgical repair of total anomalous pulmonary venous connection in early infancy. Pediatr Cardiol 2015; 36:350-7. [PMID: 25208496 DOI: 10.1007/s00246-014-1013-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
The objective of this study was to determine neurocognitive outcomes 4.5 years after surgery for TAPVC in infancy and predictors of these outcomes. A cohort having TAPVC repair at age ≤6 weeks between 1998 and 2007 were followed by the Complex Pediatric Therapies Follow-up Program at 4.5 years. Outcomes include mortality, full-scale intelligence quotient (FSIQ), verbal IQ (VIQ), performance IQ (PIQ), visual motor integration (VMI), and general adaptive composite of the Adaptive Behavior Assessment System (GAC). There were 51 infants with simple TAPVC [4 year mortality 4 (8%)], and 16 with complex TAPVC [4 year mortality 7 (44%)], hazard ratio (HR) 7.02 (95% CI 2.05-24.07, p = 0.002). Of the 47 survivors after simple TAPVC, FSIQ (SD) was 92 (17), VIQ 92 (17), PIQ 94 (15), VMI 92 (15), and GAC 92 (15). Independent predictors of neurocognitive outcome included father's socioeconomic status, mother's years of schooling, gender, post-operative base deficit, and deep hypothermic circulatory arrest (DHCA) time. Complex TAPVC was associated on univariate analysis only with PIQ [81.9 (10.2) vs. 93.6 (15.4); p = 0.012] and FSIQ [80.7 (10.1) vs. 92.0 (17.7); p = 0.017]. Original peoples accounted for 25/51 (49%) of simple and 3/16 (19%) of complex TAPVC. Original peoples race was associated with 4-year mortality [HR 6.85 (95% CI 2.15, 21.76, p = 0.001)]. Survivors of TAPVC repair in early infancy have encouraging neurocognitive outcomes. Few independent predictors of neurocognitive outcome were found, with post-operative acidosis and DHCA time being potentially modifiable. Original peoples account for an unexpected proportion of patients (42%) and have a higher mortality.
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125
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Hoashi T, Kagisaki K, Kurosaki K, Kitano M, Shiraishi I, Ichikawa H. Intrinsic obstruction in pulmonary venous drainage pathway is associated with poor surgical outcomes in patients with total anomalous pulmonary venous connection. Pediatr Cardiol 2015; 36:432-7. [PMID: 25274399 DOI: 10.1007/s00246-014-1031-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to review the surgical outcomes of conventional repair in patients with total anomalous pulmonary venous connection (TAPVC). Between 1999 and 2012, 46 patients underwent conventional TAPVC repair; of those, 14 required emergent surgery within the first 24 h after their birth for coexisting intrinsic obstruction in pulmonary venous drainage pathway (Group 1). The remaining 32 were operated on after the first day of life and were divided into two groups: with (Group 2, n = 10) and without (Group 3, n = 22) subsequently progressed pulmonary venous obstruction (PVO) after birth. A follow-up was completed on all patients, and the mean follow-up period was 7 ± 4 years (range 0.9-14). Group 1 required a significantly prolonged nitric oxide inhalation (12 ± 11 days) and mechanical ventilation support (29 ± 36 days) compared to Group 2 and Group 3. The actuarial survival rate at 10 years was 69% in Group 1, 88% in Group 2, and 96% in Group 3 (Group 1 vs. Group 3: p = 0.05). Freedom from postoperative pulmonary vein stenosis at 10 years was 39% in Group 1, 70% in Group 2, and 86% in Group 3 (Group 1 vs. Group 3: p = 0.002). However, all the ten survivors in Group 1 showed an NYHA functional status of I or II, and 60% of survivors were free from medication. Outcomes of patients with TAPVC requiring surgical repair at the day of birth for coexisting intrinsic PVO were still dismal; however, the acceptable status of current survivors has encouraged us to treat this challenging group surgically.
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Affiliation(s)
- Takaya Hoashi
- Departments of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan,
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126
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Kulik TJ. Pulmonary hypertension caused by pulmonary venous hypertension. Pulm Circ 2015; 4:581-95. [PMID: 25610595 DOI: 10.1086/678471] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/16/2014] [Indexed: 12/21/2022] Open
Abstract
The effect of pulmonary venous hypertension (PVH) on the pulmonary circulation is extraordinarily variable, ranging from no impact on pulmonary vascular resistance (PVR) to a marked increase. The reasons for this are unknown. Both acutely reversible pulmonary vasoconstriction and pathological remodeling (especially medial hypertrophy and intimal hyperplasia) account for increased PVR when present. The mechanisms involved in vasoconstriction and remodeling are not clearly defined, but increased wall stress, especially in small pulmonary arteries, presumably plays an important role. Myogenic contraction may account for increased vascular tone and also indirectly stimulate remodeling of the vessel wall. Increased wall stress may also directly cause smooth muscle growth, migration, and intimal hyperplasia. Even long-standing and severe pulmonary hypertension (PH) usually abates with elimination of PVH, but PVH-PH is an important clinical problem, especially because PVH due to left ventricular noncompliance lacks definitive therapy. The role of targeted PH therapy in patients with PVH-PH is unclear at this time. Most prospective studies indicate that these medications are not helpful or worse, but there is ample reason to think that a subset of patients with PVH-PH may benefit from phosphodiesterase inhibitors or other agents. A different approach to evaluating possible pharmacologic therapy for PVH-PH may be required to better define its possible utility.
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Affiliation(s)
- Thomas J Kulik
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; and Department of Cardiology, Division of Cardiac Critical Care, and the Pulmonary Hypertension Program, Boston Children's Hospital, Boston, Massachusetts, USA
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127
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Furlanetto G, Furlanetto BHS, Henriques SRC, Lopes LM, Miranda ET, Porto CMG, Pereira MENT, Davini C, Espinosa EC. Mixed Type Total Anomalous Pulmonary Venous Connection. World J Pediatr Congenit Heart Surg 2014; 6:26-32. [DOI: 10.1177/2150135114554660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The mixed total anomalous pulmonary connection is a rare type of congenital cardiopathy. The occurrence of multiple connections of the pulmonary veins has important implication in the diagnosis and surgical planning. These types of total anomalous pulmonary venous connection (TAPVC) and the infracardiac have higher surgical mortality. Methods: Between December 1994 and July 2013, a total of 58 children underwent surgical treatment of TAPVC. Twenty-five (43.1%) patients had supracardiac connection, 15 (25.8%) patients had intracardiac type, 12 (20.6%) patients had a mixed type, and 6 (10.3%) patients had an infracardiac type. In children with mixed TAPVC, four (33.3%) patients had type I, five (41.6%) patients had type II, and three (25.0%) patients had type III. The diagnosis of TAPVC was performed in all patients using Doppler echocardiography, and they underwent cardiopulmonary bypass with aorta-bicaval cannulation and lately we use mild hypothermia with normal flow. The drainage channels were ligated in all patients. Results: The immediate surgical results were as follows: one (16.6%) death in the infracardiac group, four (16.0%) deaths in the supracardiac group, one (8.3%) death in the mixed group, and no death in the cardiac group (no statistical difference, P = .488). Conclusion: In this series of patients, the mixed TAPVC could be corrected only with preoperative two-dimensional Doppler echocardiography with good immediate results, and we believe that the use of computed angiotomography combined with three-dimensional reconstruction may improve the surgical outcome mainly in the mixed and infracardiac group of TAPVC.
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Affiliation(s)
| | - Beatriz H. S. Furlanetto
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | - Sandra R. C. Henriques
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | | | - Eduardo T. Miranda
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | - Carolina M. G. Porto
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | | | - Claudia Davini
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | - Elssi C. Espinosa
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
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128
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Kim HS, Jeong K, Cho HJ, Choi WY, Choi YE, Ma JS, Cho YK. Total anomalous pulmonary venous return in siblings. J Cardiovasc Ultrasound 2014; 22:213-9. [PMID: 25580197 PMCID: PMC4286644 DOI: 10.4250/jcu.2014.22.4.213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/12/2014] [Accepted: 11/27/2014] [Indexed: 12/03/2022] Open
Abstract
Total anomalous pulmonary venous return (TAPVR) is a rare and critical congenital vascular anomaly that requires an early operation. However, initial symptoms of TAPVR may be non-specific, and cardiovascular findings may be minimal. The heart may not be enlarged and there is often no cardiac murmur. Without cardiac murmur, these symptoms are similar to those of respiratory distress syndrome in newborns. Therefore, a high degree of suspicion and an early diagnosis of TAPVR are important. This condition generally occurs without a family history and has a low recurrence rate, but several familial cases, including siblings, have been reported worldwide. Additionally, several chromosomal or gene abnormalities associated with TAPVR have been reported. In the case presented here, two brothers with a 6-year age gap were diagnosed with TAPVR. Surgery was performed without cardiac or neurological complications. This is the first report on TAPVR in siblings in Korea.
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Affiliation(s)
- Ho-Sung Kim
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Kumi Jeong
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Hwa-Jin Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Woo-Yeon Choi
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Young Earl Choi
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
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129
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Jones AJ, Starling LD, Keith T, Nicholl R, Seale AN. When pneumonia does not respond to antibiotics: a challenging neonatal diagnosis. Arch Dis Child Educ Pract Ed 2014; 99:221-30. [PMID: 24835272 PMCID: PMC4251205 DOI: 10.1136/archdischild-2013-304193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A J Jones
- Paediatric Department, Northwick Park Hospital, Harrow, UK
| | - L D Starling
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - T Keith
- Paediatric Department, Northwick Park Hospital, Harrow, UK
| | - R Nicholl
- Paediatric Department, Northwick Park Hospital, Harrow, UK
| | - A N Seale
- Paediatric Department, Northwick Park Hospital, Harrow, UK. Department of Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
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130
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Dyer KT, Hlavacek AM, Meinel FG, De Cecco CN, McQuiston AD, Schoepf UJ, Pietris NP. Imaging in congenital pulmonary vein anomalies: the role of computed tomography. Pediatr Radiol 2014; 44:1158-68; quiz 1155-7. [PMID: 25142330 DOI: 10.1007/s00247-014-3044-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/24/2014] [Accepted: 05/12/2014] [Indexed: 10/24/2022]
Abstract
Pulmonary venous anomalies comprise a wide spectrum of anatomical variations and their clinical presentations may vary from the relatively benign single partial anomalous pulmonary venous connection (PAPVC) to the critical obstructed total anomalous pulmonary venous connection (TAPVC). We briefly review the common anomalies encountered, while highlighting the utility that computed tomographic angiography (CTA) provides for this spectrum of extracardiac vascular malformations and connections. CTA has established itself as an invaluable imaging modality in these patients. A detailed knowledge of the CTA imaging findings in pulmonary venous anomalies is crucial to guide clinical decision-making in these patients.
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Affiliation(s)
- Kevin Todd Dyer
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Drive , Charleston, SC, 29425, USA
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131
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Padalino MA, Cavalli G, De Franceschi M, Mancuso D, Maschietto N, Vida V, Milanesi O, Stellin G. Surgical Outcomes of Total Anomalous Pulmonary Venous Connection Repair: A 22-Year Experience. J Card Surg 2014; 29:678-85. [DOI: 10.1111/jocs.12399] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Massimo A. Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padova Medical School; Padova Italy
| | - Giacomo Cavalli
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padova Medical School; Padova Italy
| | - Marco De Franceschi
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padova Medical School; Padova Italy
| | - Daniela Mancuso
- Division of Cardiology; Public Health Hospital; Cittadella Italy
| | - Nicola Maschietto
- Pediatric Cardiology, Department of Women and Child's Health; University of Padova Medical School; Padova Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padova Medical School; Padova Italy
| | - Ornella Milanesi
- Pediatric Cardiology, Department of Women and Child's Health; University of Padova Medical School; Padova Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padova Medical School; Padova Italy
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132
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Luciani GB, Hoxha S, Lucchese G, Rebonato M, Rossetti L, Faggian G, Mazzucco A. Neonatal Repair of Truncus Arteriosus With “Scimitar-Like” Mixed Total Pulmonary Venous Return. Ann Thorac Surg 2014; 97:e167-9. [DOI: 10.1016/j.athoracsur.2014.02.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/22/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
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133
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Yoshimura N, Fukahara K, Yamashita A, Doki Y, Takeuchi K, Higuma T, Senda K, Toge M, Matsuo T, Nagura S, Aoki M, Sakata K, Obi H. Current topics in surgery for isolated total anomalous pulmonary venous connection. Surg Today 2014; 44:2221-6. [DOI: 10.1007/s00595-014-0877-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
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134
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Abstract
OBJECTIVE The specialty of pediatric cardiac critical care has undergone rapid scientific and clinical growth in the last 25 years. The Board of Directors of the Pediatric Cardiac Intensive Care Society assembled an updated list of sentinel references focused on the critical care of children with congenital and acquired heart disease. We encouraged board members to select articles that have influenced and informed their current practice or helped to establish the standard of care. The objective of this article is to provide clinicians with a compilation and brief summary of these updated 100 useful references. DATA SOURCES The list of 'One Hundred Useful References for Pediatric Cardiac Intensive Care' (2004) and relevant literature to the practice of cardiac intensive care. DATA SELECTION A subset of Pediatric Cardiac Intensive Care Society board members compiled the initial list of useful references in 2004, which served as the basis of the new updated list. Suggestions for relevant articles were submitted by the Pediatric Cardiac Intensive Care Society board members and selected pediatric cardiac intensivists with an interest in this project following the Society's meeting in 2010. Articles were considered for inclusion if they were named in the original list from 2004 or were suggested by Pediatric Cardiac Intensive Care Society board members and published before December 31, 2011. DATA EXTRACTION Following submission of the complete list by the Pediatric Cardiac Intensive Care Society board and contributing Society members, articles were complied by the two co-first authors (D.A., D.K.). The authors also performed Medline searches to ensure comprehensive inclusion of all relevant articles. The final list was then submitted to the Pediatric Cardiac Intensive Care Society board members, who ranked each publication. DATA SYNTHESIS Rankings were compiled and the top 100 articles with the highest scores were selected for inclusion in this publication. The two co-first authors (D.A., D.K.) reviewed all existing summaries and developed summaries of the newly submitted articles. CONCLUSIONS An updated compilation of 100 useful references for the critical care of children with congenital and acquired heart disease has been compiled and summarized here. Clinicians and trainees may wish to use this document as a reference for education in this complex and challenging subspecialty.
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135
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Abstract
Approximately 1-2 per 1000 newborn babies have a cardiac defect that is potentially life-threatening usually because either the systemic or the pulmonary blood flow is dependent on a patent ductus arteriosus. A significant proportion of newborns with such cardiac defects are being discharged from well-baby nurseries without a diagnosis and therefore risk circulatory collapse and death. This risk is greatest for defects with duct-dependent systemic circulation, notably aortic arch obstruction, but is also significant in transposition of the great arteries, for example. The solution to this problem, apart from improving prenatal detection rates, is to introduce effective neonatal screening including routine pulse oximetry.
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136
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Schranz D, Michel-Behnke I. Advances in interventional and hybrid therapy in neonatal congenital heart disease. Semin Fetal Neonatal Med 2013; 18:311-21. [PMID: 23759171 DOI: 10.1016/j.siny.2013.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In addition to the considerable surgical advances in treating congenital heart diseases, hybrid and transcatheter therapies have become a cornerstone of neonatal cardiology within the last decade. Approaches to the care of cyanotic newborns with congenital heart disease focused on manipulations of the inter-atrial septum, right ventricular outflow tract obstructions, and on the arterial duct as the source for pulmonary blood flow. Currently, fewer interventional procedures are used in newborns and small infants to treat excessive pulmonary blood flow caused by shunt lesions, but transcatheter techniques and hybrid strategies have been developed to treat newborns suffering from inadequate systemic perfusion. However, transcatheter techniques are still not available to treat failing systemic ventricles without obvious structural disorders of the myocardium or dilated cardiomyopathies in newborns and infancy, despite new surgical-interventional strategies are already developed to avoid or to delay early heart transplantation. In conclusion, material and technical improvements have enabled transcatheter techniques to replace medical-based therapies to solve structurally dependent cardiovascular diseases. However, evidence-based and long-term follow-up data are required.
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Affiliation(s)
- Dietmar Schranz
- Department of Pediatric Cardiology, Pediatric Heart Center, Justus-Liebig-University Giessen, Germany.
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137
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Itoi T. Stenting as a possible new therapeutic strategy to the obstructed TAPVC. J Cardiol Cases 2013; 8:e93-e94. [PMID: 30546753 PMCID: PMC6281487 DOI: 10.1016/j.jccase.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Indexed: 11/04/2022] Open
Affiliation(s)
- Toshiyuki Itoi
- Department of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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138
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Naha K, Vivek G, Shetty RK, Nayak K. Late presentation of TAPVC with multiple cerebral abscesses. BMJ Case Rep 2013; 2013:bcr-2013-009778. [PMID: 23845677 DOI: 10.1136/bcr-2013-009778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 24-year-old man, presenting with fever, headache, vomiting and seizures, subsequently diagnosed with cyanotic congenital heart disease. Evaluation revealed non-obstructive supracardiac total anomalous pulmonary venous connection (TAPVC) as the underlying disorder. Surprisingly, the patient denied any past cardiac symptoms. Presentation in adulthood is infrequent for TAPVC, and primary manifestation with cerebral abscesses is still more unusual.
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Affiliation(s)
- Kushal Naha
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
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139
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Shen Q, Pa M, Hu X, Wang J. Role of plain radiography and CT angiography in the evaluation of obstructed total anomalous pulmonary venous connection. Pediatr Radiol 2013; 43:827-35. [PMID: 23341089 DOI: 10.1007/s00247-012-2609-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 11/17/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Obstructed total anomalous pulmonary venous connection (TAPVC) is frequently misdiagnosed as pulmonary disease and without operative correction early death is common. It is important to make a correct diagnosis before surgery. OBJECTIVE The purpose of this study was to describe the chest radiographic features of obstructed TAPVC and compare CT angiography with transthoracic echocardiography in the evaluation of obstructed TAPVC. MATERIALS AND METHODS Eighteen children with obstructed TAPVC were assessed. Their clinical and imaging data were retrospectively reviewed. The characteristic radiographic findings were analyzed and compared with surgical results, and the diagnostic accuracy of CT angiography and transthoracic echocardiography was evaluated in terms of pulmonary venous drainage and obstruction detection. RESULTS The common radiographic features included pulmonary venous congestion or edema or both (16 of 18 cases, 89%), and absence of cardiomegaly (12 of 18 cases, 67%). CT angiography correctly diagnosed TAPVC and clearly revealed the draining sites in all children (five with supracardiac TAPVC, three with cardiac TAPVC, eight with infracardiac TAPVC and two with mixed TAPVC). The diagnostic agreement between CT angiography and surgery was 100%. Transthoracic echocardiography only correctly revealed the draining sites in 11 children (5 with supracardiac TAPVC, 2 with cardiac TAPVC and 4 with infracardiac TAPVC). The diagnostic agreement between transthoracic echocardiography and surgery was 61%. The diagnostic accuracy of CT angiography was higher than that of transthoracic echocardiography (P = 0.0156). Thirty-four sites of obstruction were correctly detected by CT angiography (11 in the mediastinum, 1 at the diaphragmatic level, 9 below the diaphragm and 13 stenotic individual pulmonary veins in the lung). The diagnostic agreement between CT angiography and surgery was 92%. Transthoracic echocardiography only correctly detected 15 sites of obstruction (11 in the mediastinum, 1 at the diaphragmatic level and 3 below the diaphragm). The diagnostic agreement between transthoracic echocardiography and surgery was 41%. The rate of detection for sites of obstruction with transthoracic echocardiography was much lower than that of CT angiography (P = 0.0002). CONCLUSION In children with obstructed TAPVC, plain radiographs usually show a characteristic pattern of pulmonary venous congestion or edema, or both, and a normal cardiac silhouette. CT angiography is superior to transthoracic echocardiography in the evaluation of pulmonary venous drainage and obstruction, especially in children with infracardiac and mixed TAPVC.
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Affiliation(s)
- Quanli Shen
- Department of Radiology, Children's Hospital, Fudan University, 399 Wanyuan St., Shanghai, China, 201102
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140
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Walsh MJ, Ungerleider RM, Aiello VD, Spicer D, Giroud JM. Anomalous pulmonary venous connections and related anomalies: nomenclature, embryology, anatomy, and morphology. World J Pediatr Congenit Heart Surg 2013; 4:30-43. [PMID: 23799752 DOI: 10.1177/2150135112458439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article combines material from three complementary overviews presented in the Symposium on Pulmonary Venous Anomalies during the Joint Meeting of the World Society for Pediatric and Congenital Heart Surgery and Sociedad Latina de Cardiologia y Cirugia Cardiovascular Pediátrica in Lima, Peru. We discuss the embryologic basis for nomenclature, the hierarchical diagnostic categories, and the important anatomic and morphologic characteristics of anomalous pulmonary venous connections. The anatomic descriptions help to guide an understandable and sensible approach to the diagnosis and surgical management of these various disorders.
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Affiliation(s)
- Michael J Walsh
- Division of Pediatric Cardiology, Brenner Children's Hospital, Wake Forest University Medical Center, Winston Salem, NC 27157, USA.
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141
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Doksöz Ö, Güven B, Demirpençe S, Özdemir R, Meşe T, Tavli V, Alayunt EA. Coarctation of the aorta with infracardiac total anomalous pulmonary venous drainage: a rare combination. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:778-80. [PMID: 23698373 DOI: 10.5761/atcs.cr.13-00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 7-day-old female neonate was referred to the pediatric emergency department due to cyanosis and respiratory distress. Her arterial oxygen saturation was 65%. The Coarctation of the aorta, infracardiac total anomalous pulmonary venous drainage without obstruction and pulmonary artery hypertension were diagnosed by echocardiography. Emergency corrective surgery was done without confirming the diagnosis with cardiac magnetic resonance imaging (MRI) or cardiac catheterization due to her poor clinical status. The postoperative course was uneventful and the patient was extubated after the sixth day of surgery and discharged after 14 days.
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Affiliation(s)
- Önder Doksöz
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
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142
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Degenhardt K, Singh MK, Aghajanian H, Massera D, Wang Q, Li J, Li L, Choi C, Yzaguirre AD, Francey LJ, Gallant E, Krantz ID, Gruber PJ, Epstein JA. Semaphorin 3d signaling defects are associated with anomalous pulmonary venous connections. Nat Med 2013; 19:760-5. [PMID: 23685842 DOI: 10.1038/nm.3185] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 04/04/2013] [Indexed: 01/22/2023]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a potentially lethal congenital disorder that occurs when the pulmonary veins do not connect normally to the left atrium, allowing mixing of pulmonary and systemic blood. In contrast to the extensive knowledge of arterial vascular patterning, little is known about the patterning of veins. Here we show that the secreted guidance molecule semaphorin 3d (Sema3d) is crucial for the normal patterning of pulmonary veins. Prevailing models suggest that TAPVC occurs when the midpharyngeal endothelial strand (MES), the precursor of the common pulmonary vein, does not form at the proper location on the dorsal surface of the embryonic common atrium. However, we found that TAPVC occurs in Sema3d mutant mice despite normal formation of the MES. In these embryos, the maturing pulmonary venous plexus does not anastomose uniquely with the properly formed MES. In the absence of Sema3d, endothelial tubes form in a region that is normally avascular, resulting in aberrant connections. Normally, Sema3d provides a repulsive cue to endothelial cells in this area, establishing a boundary. Sequencing of SEMA3D in individuals with anomalous pulmonary veins identified a phenylalanine-to-leucine substitution that adversely affects SEMA3D function. These results identify Sema3d as a crucial pulmonary venous patterning cue and provide experimental evidence for an alternate developmental model to explain abnormal pulmonary venous connections.
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Affiliation(s)
- Karl Degenhardt
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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143
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Seale AN, Uemura H, Webber SA, Partridge J, Roughton M, Ho SY, McCarthy KP, Jones S, Shaughnessy L, Sunnegardh J, Hanseus K, Berggren H, Johansson S, Rigby ML, Keeton BR, Daubeney PE. Total anomalous pulmonary venous connection: Outcome of postoperative pulmonary venous obstruction. J Thorac Cardiovasc Surg 2013; 145:1255-62. [DOI: 10.1016/j.jtcvs.2012.06.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 05/09/2012] [Accepted: 06/12/2012] [Indexed: 11/16/2022]
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144
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Schranz D, Jux C, Akintuerk H. Novel catheter-interventional strategy for intracardiac connecting of total anomalous pulmonary venous return in newborns with hypoplastic left heart-syndrome prior to hybrid approach. Catheter Cardiovasc Interv 2013; 82:564-8. [PMID: 23255382 DOI: 10.1002/ccd.24783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 10/31/2012] [Accepted: 12/07/2012] [Indexed: 11/12/2022]
Abstract
Total anomalous pulmonary venous return (TAPVR) associated with hypoplastic left heart-syndrome (HLHS) is a rare condition, and from the therapeutical point of view associated with a high Aristotle score and thus increased mortality. We report two newborns with HLHS, one with a supracardiac type of TAPVR and mildly obstructed left vertical vein, and the other with a supracardiac type of TAPVR in association with cor triatriatum and severely obstructed left-sided vertical vein. In both patients, radio frequency perforation from the pulmonary venous confluence to the systemic venous atrium was performed with consecutive gradual balloon dilatation, followed by stent placement in one. Hybrid stage I, and comprehensive stage II were successfully performed thereafter. Currently, both are awaiting their Fontan completion. Transcatheter intracardiac connecting of supracardiac type of TAPVR in newborns with HLHS is feasible and might render these children suitable candidates for further hybrid approach.
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Affiliation(s)
- Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
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145
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Hasegawa T, Oshima Y, Maruo A, Matsuhisa H, kadowaki T, Nakai H. Acute lung injury following cardiac surgery in children with unilateral pulmonary agenesis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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146
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Dual-Source 256-MDCT for Diagnosis of Anomalous Pulmonary Venous Drainage in Pediatric Population. AJR Am J Roentgenol 2013; 200:W163-9. [DOI: 10.2214/ajr.11.8348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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147
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Non-ECG-gated MDCTA of infracardiac total anomalous pulmonary venous connection in neonates and young infants. Herz 2013; 38:539-43. [DOI: 10.1007/s00059-012-3728-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/25/2012] [Accepted: 10/28/2012] [Indexed: 11/30/2022]
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148
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Mądry W, Karolczak MA. Totally anomalous pulmonary venous drainage - supracardiac type: ultrasound assessment of anatomically determined stenosis of the vertical vein collecting pulmonary venous return. J Ultrason 2012; 12:479-86. [PMID: 26675781 PMCID: PMC4603229 DOI: 10.15557/jou.2012.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/06/2012] [Accepted: 12/11/2012] [Indexed: 11/29/2022] Open
Abstract
The diagnosis of the congenital heart defects, among others totally anomalous pulmonary venous drainage, is based on echocardiography. While the visualization of intracardiac structures rarely causes significant difficulties, the vessels positioned outside the heart, e.g. the pulmonary veins, are often hidden behind tissues impermeable to ultrasounds, which may necessitate the use of other imaging methods, such as computer tomography, nuclear magnetic resonance or angiocardiography. The serious limitation of these techniques, especially in pediatric age, is the necessity to administer general anesthesia and contrast media. In order to obtain clear images, the appropriate concentration of a contrast agent in the vessels is necessary, which is not always possible in a patient with severe circulatory failure. Therefore, every effort should be made to obtain as much information necessary for treatment determination as possible from echocardiography, in spite of its limitations. A significant morphological factor of totally anomalous pulmonary venous drainage is the connection between the pulmonary and systemic veins, which in the supracardiac type is the vertical vein draining into the left brachiocephalic vein. The narrowing of this connection impedes the return of the blood from the lungs, which leads to the secondary edema and severe, abrupt cardiorespiratory insufficiency. Such a narrowing should be sought for in every case of totally anomalous pulmonary venous drainage since it constitutes an indication for an urgent surgery. On the basis of own experience and information obtained from the pertinent literature, the authors describe the rules and criteria of the diagnosis of this rare supracardiac form of the heart defect with the presence of the vertical vein which may undergo stenosis due to a phenomenon called the anatomical or bronchoarterial vise. It is formed when the vessel “pushes through” a narrow opening bordered by the left pulmonary artery from the inferior side as well as the left main bronchus and the arterial duct or ligament from the superior side. This article describes a technique of echocardiographic test enabling the precise visualization of the vessel's course and the differentiation from a more common variant of the defect – without external stenosis.
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Affiliation(s)
- Wojciech Mądry
- II Katedra i Klinika Kardiochirurgii i Chirurgii Ogólnej Dzieci, Warszawki Uniwersytet Medyczny, Warszawa, Polska
| | - Maciej A Karolczak
- II Katedra i Klinika Kardiochirurgii i Chirurgii Ogólnej Dzieci, Warszawki Uniwersytet Medyczny, Warszawa, Polska
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149
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Katre R, Burns SK, Murillo H, Lane MJ, Restrepo CS. Anomalous Pulmonary Venous Connections. Semin Ultrasound CT MR 2012; 33:485-99. [DOI: 10.1053/j.sult.2012.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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150
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Hemodynamic Index for Risk Stratification After Neonatal Total Anomalous Pulmonary Venous Drainage Repair. Ann Thorac Surg 2012; 94:1584-7. [DOI: 10.1016/j.athoracsur.2012.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 06/07/2012] [Accepted: 06/11/2012] [Indexed: 11/23/2022]
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