1
|
Sunthankar KI, Weingarten AJ, Doyle TP, Nicholson GT, Sunthankar SD. Pulmonary Veins: Not Always Where You Expect Them. CASE (PHILADELPHIA, PA.) 2024; 8:97-102. [PMID: 38524991 PMCID: PMC10954582 DOI: 10.1016/j.case.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Multimodality imaging is important in patients with ACHD and challenging anatomy. •Complex congenital anatomy and physiology requires multidisciplinary discussions. •Image-guided percutaneous intervention may be warranted after TAPVR repair.
Collapse
Affiliation(s)
- Kathryn I. Sunthankar
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Angela J. Weingarten
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Thomas P. Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas P. Doyle
- Thomas P. Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - George T. Nicholson
- Thomas P. Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sudeep D. Sunthankar
- Thomas P. Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
2
|
Catalán Cabrera A, Condori Alvino K. [Percutaneous closure of vertical vein after supra-cardiac total anomalous pulmonary venous connection repair, using atrial septal defect occluder. A case report]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:194-198. [PMID: 38298416 PMCID: PMC10824741 DOI: 10.47487/apcyccv.v4i4.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/09/2023] [Indexed: 02/02/2024]
Abstract
In patients operated on for total supracardiac anomalous pulmonary venous connection (TAPVC-SC), not ligating the vertical vein (VV) routinely helps to maintain greater hemodynamic stability in the postoperative period, and in many cases, spontaneous closure will be achieved. However, if the VV remains patent, it leads to a pre-tricuspid shunt with significant pulmonary hyperflow, requiring surgical or percutaneous closure. We present the case of a post-operated patient for non-obstructive TAPVC-SC with patent VV, in whom percutaneous closure was performed using an atrial septal Occluder.
Collapse
Affiliation(s)
- Alex Catalán Cabrera
- Área de Cateterismo Cardiaco Pediátrico, Instituto Nacional de Salud del Niño de San Borja, Lima, Perú.Área de Cateterismo Cardiaco PediátricoInstituto Nacional de Salud del Niño de San BorjaLimaPerú
| | - Karen Condori Alvino
- Área de Cateterismo Cardiaco Pediátrico, Instituto Nacional de Salud del Niño de San Borja, Lima, Perú.Área de Cateterismo Cardiaco PediátricoInstituto Nacional de Salud del Niño de San BorjaLimaPerú
| |
Collapse
|
3
|
Transcatheter closure of patent vertical vein after repair of total anomalous pulmonary venous connection: a case series. Cardiol Young 2021; 31:1853-1857. [PMID: 33977891 DOI: 10.1017/s1047951121001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Total anomalous pulmonary venous connection is a rare cyanotic CHD that requires surgical repair. An unligated vertical vein after total anomalous pulmonary venous connection surgery may help to decrease the episodes of post-operative pulmonary hypertensive crises, low cardiac output syndrome, and mortality. The aim was to assess long-term outcome and our post-operative transcatheter vertical vein closure experiences in five patients with repaired total anomalous pulmonary venous connection patients. METHODS A retrospective study was conducted in five cases with an unligated vertical vein following repair of supra-cardiac total anomalous pulmonary venous connection at our hospital from 2011 through 2018. Patients characteristics, cardiac catheterisation findings, surgical, and transcatheter procedural details were retrospectively analysed. RESULTS Transcatheter closure of the unligated vertical vein was technically successful in all the patients. Procedure-related complications were not observed in any of the patients. No long-term complication was found. CONCLUSIONS We suggest that transcatheter closure of the patent vertical vein is an effective and well-tolerated alternative to the surgical approach.
Collapse
|
4
|
Nagao H, Tominaga K, Kamei N, Tanaka T. Double drainage of total anomalous pulmonary venous connection revealed after surgical repair of a supracardiac total anomalous pulmonary venous connection. Clin Case Rep 2020; 8:3013-3017. [PMID: 33363870 PMCID: PMC7752448 DOI: 10.1002/ccr3.3352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/07/2020] [Accepted: 08/22/2020] [Indexed: 11/06/2022] Open
Abstract
Mixed type TAPVC with double drainage, where the second vertical vein enlarged rather than atrophied after surgery. If we did not recognize left-to-right shunting before surgery, it can be treated with catheterization as demonstrated by our case.
Collapse
Affiliation(s)
- Hiroyuki Nagao
- Department of CardiologyHyogo prefectural Kobe children's hospitalKobeJapan
| | - Kenta Tominaga
- Department of CardiologyHyogo prefectural Kobe children's hospitalKobeJapan
| | - Naoya Kamei
- Department of CardiologyHyogo prefectural Kobe children's hospitalKobeJapan
| | - Toshikatsu Tanaka
- Department of CardiologyHyogo prefectural Kobe children's hospitalKobeJapan
| |
Collapse
|
5
|
Layton GR, Koulouroudias M, Issa E, Jepson S, Corno AF, Dennison AR. Unligated vertical vein presenting as a large atrio-portal shunt in adulthood: a case report. J Surg Case Rep 2020; 2020:rjaa377. [PMID: 33101639 PMCID: PMC7568959 DOI: 10.1093/jscr/rjaa377] [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: 08/11/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
A 28-year-old male with infra-cardiac totally anomalous pulmonary venous connection (TAPVC) repaired as new-born presented in adulthood with right heart strain and very large left atrium to portal vein vessel. Residual connections from pulmonary veins to systemic circulation are believed to represent persistent ‘vertical veins’ (VV) not ligated at the time of the initial surgery. In our patient, since endovascular occlusion was not judged suitable, the anomalous vessel was surgically ligated and resected. A review of the literature failed to find such a procedure reported in an adult patient and analyzed the intra-operative ligation of VV during repair of TAPVC.
Collapse
Affiliation(s)
- Georgia R Layton
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Marinos Koulouroudias
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Eyad Issa
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| | - Steve Jepson
- Department of Radiology, Leicester General Hospital, Leicester, UK
| | - Antonio F Corno
- University of Texas Health, McGovern Medical School, Houston, Texas, USA
| | - Ashley R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK
| |
Collapse
|
6
|
Akam-Venkata J, Turner DR, Joshi A, Aggarwal S, Gupta P. Diagnosis and Management of the Unligated Vertical Vein in Repaired Total Anomalous Pulmonary Venous Connection. World J Pediatr Congenit Heart Surg 2019; 11:NP229-NP231. [DOI: 10.1177/2150135118817491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During initial repair of supracardiac total anomalous pulmonary venous connection (TAPVC), the vertical vein (VV) is sometimes left patent (not ligated or divided) in the hope that this strategy may reduce the likelihood or severity of postoperative pulmonary hypertensive crises. We report a case of a 35-year-old pregnant patient with previously repaired supracardiac TAPVC who presented with atrial arrhythmia and right heart dilation. A cardiac magnetic resonance imaging study confirmed the diagnosis of patency of the vertical vein and right heart dilation. The VV was occluded with a catheter-delivered vascular occlusion device through a percutaneous approach, resulting in resolution of right heart dilation and arrhythmia. This case highlights the role of cross-sectional imaging as an adjunct to echocardiography in adults with repaired congenital heart disease.
Collapse
Affiliation(s)
- Jyothsna Akam-Venkata
- Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Daniel R. Turner
- Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Aparna Joshi
- Department of Pediatric Imaging, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Sanjeev Aggarwal
- Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Pooja Gupta
- Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, MI, USA
| |
Collapse
|
7
|
Gangadhara MB, Magee AG. Transcatheter occlusion of partial anomalous pulmonary venous connection with dual drainage to left atrium. Ann Pediatr Cardiol 2019; 12:144-146. [PMID: 31143042 PMCID: PMC6521669 DOI: 10.4103/apc.apc_72_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Transcatheter therapy for partial anomalous pulmonary venous connection with dual drainage is unique and rarely reported. We report a 69-year-old female with recurrent brain abscess and partial anomalous connection of the left upper pulmonary vein with dual drainage to the vertical vein (VV) and left atrium (LA). Transcatheter occlusion of the VV was done using an 18-mm St. Jude Amplatzer Vascular Plug II, thus redirecting the left-sided pulmonary venous drainage to LA. Careful evaluation of partial anomalous pulmonary venous drainage with cross-sectional imaging is essential to allow the delineation of dual connections, enabling a less invasive transcatheter treatment approach.
Collapse
Affiliation(s)
- Madhu Bangalore Gangadhara
- Department of Paediatric Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alan G Magee
- Department of Paediatric Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| |
Collapse
|
8
|
Charbel R, Hanna N, Daou L, Saliba Z. Catheter closure of a recanalized vertical vein after repair of total anomalous pulmonary venous connection. Clin Case Rep 2018; 6:843-846. [PMID: 29744069 PMCID: PMC5930228 DOI: 10.1002/ccr3.1443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/26/2017] [Accepted: 01/30/2018] [Indexed: 11/27/2022] Open
Abstract
The vertical vein is sometimes left open in repair of total anomalous pulmonary venous connection. It usually closes later but can remain patent leading to a significant shunt. We describe a recanalized vertical vein in a 7‐year‐old having undergone repair in infancy. It was closed using an Amplatzer device.
Collapse
Affiliation(s)
- Ramy Charbel
- Department of Pediatrics; Hotel-Dieu de France University Medical Center; Beirut Lebanon
| | - Najib Hanna
- Department of Pediatrics; Hotel-Dieu de France University Medical Center; Beirut Lebanon
- Department of Pediatric Cardiology; Hotel-Dieu de France University Medical Center; Beirut Lebanon
| | - Linda Daou
- Department of Pediatrics; Hotel-Dieu de France University Medical Center; Beirut Lebanon
- Department of Pediatric Cardiology; Hotel-Dieu de France University Medical Center; Beirut Lebanon
| | - Zakhia Saliba
- Department of Pediatrics; Hotel-Dieu de France University Medical Center; Beirut Lebanon
- Department of Pediatric Cardiology; Hotel-Dieu de France University Medical Center; Beirut Lebanon
| |
Collapse
|
9
|
Jain S, Bachani NS, Pinto RJ, Dalvi BV. Dual pathology causing severe pulmonary hypertension following surgical repair of total anomalous pulmonary venous connection: Successful outcome following serial transcatheter interventions. Ann Pediatr Cardiol 2018; 11:79-82. [PMID: 29440835 PMCID: PMC5803982 DOI: 10.4103/apc.apc_1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Surgical repair of total anomalous pulmonary venous connection (TAPVC) can be complicated by the development of pulmonary venous stenosis later on. In addition, the vertical vein, if left unligated, can remain patent and lead to hemodynamically significant left to right shunting. We report an infant who required transcatheter correction of both these problems after surgical repair of TAPVC.
Collapse
Affiliation(s)
| | - Neeta S Bachani
- Glenmark Cardiac Center, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Robin J Pinto
- Glenmark Cardiac Center, Holy Family Hospital, Mumbai, Maharashtra, India
| | | |
Collapse
|
10
|
Zhao K, Wang H, Wang Z, Zhu H, Fang M, Zhu X, Zhang N, Song H. Early- and intermediate-term results of surgical correction in 122 patients with total anomalous pulmonary venous connection and biventricular physiology. J Cardiothorac Surg 2015; 10:172. [PMID: 26602895 PMCID: PMC4659209 DOI: 10.1186/s13019-015-0387-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 11/18/2015] [Indexed: 12/05/2022] Open
Abstract
Background We retrospectively reported our 26-year experience with operative repair of total anomalous pulmonary venous connection (TAPVC) with biventricular physiology. Methods Between December 1982 and December 2008, 122 TAPVC patients with biventricular heart underwent surgical repair in our department. Moderate or deep hypothermia was induced at the time of cardiopulmonary bypass (CPB). Follow-up was conducted for 5 postoperative years. Surgical outcomes of early and intermediate deaths after TAPVC repair were retrospectively analyzed. Results Six deaths occurred operatively; and three deaths, during follow-up. The 5-year survival rates after TAPVC repair was 92.6 %, without gradient across the anastomosis. The survival rate of the patients who were younger was 78.8 %, significantly lower than those older than 1 year. It was also lower in those who were less than 6 kg in weight. Three patients died during follow-up. Three patients died of ventricular arrhythmia, right heart failure, and pneumonia, respectively, during follow-up. If the left atrium pressure was higher than 15 mm Hg, the snare of the vertical vein was loosened after CPB ceased in the patients with supracardiac connection. It decreased from 21 ± 5 to 13 ± 3 mm Hg. The vertical vein was ligated in 57 cases and left open in 20 cases. A patient with an intact vertical vein had a large shunt and was cured by intervention afterward. Supraventricular arrhythmia occurred in 19 patients with the supercardiac type repaired through a biatrial incision. One patient died of ventricular arrhythmia, and none of the remaining patients had arrhythmias. Conclusion Surgical treatment of TAPVC carried a low operative risk and had satisfactory immediate and intermediate results. Age younger than 1 year and weight less than 6 kg were risk factors. It was a good choice to leave the vertical vein open in the patients with a left atrial pressure higher than 15 mm Hg.
Collapse
Affiliation(s)
- Keyan Zhao
- Department of Cardiac Surgery, Shenyang Northern Hospital, 83 Wenhua Road, Shenhe District, Shenyang, 110840, Liaoning Province, China
| | - Huishan Wang
- Department of Cardiac Surgery, Shenyang Northern Hospital, 83 Wenhua Road, Shenhe District, Shenyang, 110840, Liaoning Province, China.
| | - Zengwei Wang
- Department of Cardiac Surgery, Shenyang Northern Hospital, 83 Wenhua Road, Shenhe District, Shenyang, 110840, Liaoning Province, China
| | - Hongyu Zhu
- Department of Cardiac Surgery, Shenyang Northern Hospital, 83 Wenhua Road, Shenhe District, Shenyang, 110840, Liaoning Province, China
| | - Minhua Fang
- Department of Cardiac Surgery, Shenyang Northern Hospital, 83 Wenhua Road, Shenhe District, Shenyang, 110840, Liaoning Province, China
| | - Xianyang Zhu
- Department of Cardiac Surgery, Shenyang Northern Hospital, 83 Wenhua Road, Shenhe District, Shenyang, 110840, Liaoning Province, China
| | - Nanbin Zhang
- Department of Cardiac Surgery, Shenyang Northern Hospital, 83 Wenhua Road, Shenhe District, Shenyang, 110840, Liaoning Province, China
| | - Hengchang Song
- Department of Cardiac Surgery, Shenyang Northern Hospital, 83 Wenhua Road, Shenhe District, Shenyang, 110840, Liaoning Province, China
| |
Collapse
|
11
|
Wilson W, Horlick E, Benson L. Successful transcatheter occlusion of an anomalous pulmonary vein with dual drainage to the left atrium. Catheter Cardiovasc Interv 2015; 85:1212-6. [PMID: 25384927 DOI: 10.1002/ccd.25734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 11/03/2014] [Indexed: 11/07/2022]
Abstract
We describe a case of a scimitar syndrome "variant" where dual drainage existed from the right upper and middle pulmonary veins to the inferior vena cava and left atrium. Device closure of the anomalous vein at the level of the connection to the IVC was successful in achieving diversion of pulmonary venous flow to the left atrium. Vigilance during work-up of anomalous pulmonary venous drainage (whether isolated or associated with other cardiac defects that may be amenable to device closure) is important to define the presence of dual connections to the left atrium, in which case a less-invasive transcatheter approach may be feasible.
Collapse
Affiliation(s)
- W Wilson
- Toronto Congenital Cardiac Centre for Adults, Toronto, Ontario, Canada
| | - E Horlick
- Toronto Congenital Cardiac Centre for Adults, Toronto, Ontario, Canada
| | - L Benson
- Toronto Congenital Cardiac Centre for Adults, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Lombardi M, Tagliente MR, Pirolo T, Massari E, Sisto M, Vairo U. Transcatheter closure of an unligated vertical vein with an Amplatzer Vascular Plug-II device. J Cardiovasc Med (Hagerstown) 2014; 17 Suppl 2:e221-e223. [PMID: 25405948 DOI: 10.2459/jcm.0000000000000197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: The usual surgical practice after repair of a Total Anomalous Pulmonary Venous Connection (TAPVC) is to ligate the vertical vein (VV). Many surgeons find it expedient to leave the VV unligated to reduce pulmonary arterial pressure, decrease perioperative pulmonary hypertensive crisis, provide better hemodynamics postoperatively (1), and enable the adaptation of cardiac chambers to a new workload. Afterwards, the unligated VV may cause significant left-to-right shunt, likewise an atrial septal defect, mandating later surgical ligation or device closure (2). This report details transcatheter occlusion of a patent VV using a device Amplatzer Vascular Plug II, after TAPVC repair in early infancy. The transcatheter occlusion of an unligated VV after repair of supracardiac TAPVC represents an effective alternative to surgical redo. The device Amplatzer Vascular Plug II achieves great results.
Collapse
Affiliation(s)
- M Lombardi
- Department of Pediatric Cardiology, Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | | | | | | | | | | |
Collapse
|
13
|
Devendran V, Wilson N, Jesudian V. Percutaneous closure of a large unligated vertical vein using the Amplatzer Vascular Plug II after supracardiac total anomalous pulmonary venous connection (TAPVC) repair. Pediatr Cardiol 2014; 34:1976-8. [PMID: 23052665 DOI: 10.1007/s00246-012-0519-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 09/06/2012] [Indexed: 11/25/2022]
Abstract
It is well known that the vertical vein (VV) may have to be left open after repair of a total anomalous pulmonary venous connection (TAPVC) in children with preoperative obstruction, whose left heart chambers are small (Cope et al. in Ann Thorac Surg 64:23-29, 3). An unligated VV has been found to reduce pulmonary arterial pressure, decrease perioperative pulmonary hypertensive crisis, and provide better hemodynamics postoperatively (Chowdhry et al. in J Thorac Cardiovasc Surg 133:1286-1294, 2). Although these VVs are expected to close later, they may remain patent in about half of these children (Cheung et al. J Paediatr Child Health 41:361-364, 1).The patent VVs may be a cause for significant left-to-right shunting, and the children may be symptomatic. The case report describes a child who had a large patent VV after repair of supracardiac TAPVC and its closure using the Amplatzer Vascular Plug II device.
Collapse
Affiliation(s)
- Vimalarani Devendran
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J. J. Nagar, Mogappair, Chennai, 600037, India
| | | | | |
Collapse
|