1
|
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
|
2
|
Watanabe S, Nakata T, Suehiro S, Yasuda K, Nakashima S, Oda T. Primary sutureless repair concomitant with the Warden procedure. Asian Cardiovasc Thorac Ann 2023; 31:142-144. [PMID: 36544270 DOI: 10.1177/02184923221147833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 2-month-old girl who had supracardiac total anomalous pulmonary venous connection (Darling classification type 1b) was referred to our institution. Computed tomography showed that multiple right upper pulmonary veins drained into the vertical vein, near the entry to the superior vena cava. The common pulmonary venous chamber was located lower right than usual, and right upper pulmonary veins were far from the common chamber. We successfully performed primary sutureless repair concomitant with the Warden procedure. Postoperative computed tomography showed unobstructed pulmonary veins and superior vena cava routes, and the vertical vein between right upper and lower pulmonary veins shrank slightly.
Collapse
Affiliation(s)
- Seito Watanabe
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Tomohiro Nakata
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Syoichi Suehiro
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kenji Yasuda
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Shigeki Nakashima
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Teiji Oda
- Department of Cardiovascular Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| |
Collapse
|
3
|
Bae Y, Jang WS, Song K. Surgical correction of total anomalous pulmonary venous return in an adult patient. J Cardiothorac Surg 2022; 17:237. [PMID: 36123587 PMCID: PMC9487107 DOI: 10.1186/s13019-022-01990-9] [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: 06/13/2022] [Accepted: 08/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Total anomalous pulmonary venous return (TAPVR) is rare congenital heart disease. Most TAPVRs require surgical corrections in the neonatal period and survival to adulthood without surgical correction is extremely rare. Most untreated patients with large atrial septal defects and no pulmonary venous obstruction have pulmonary vascular damage from pulmonary over circulation. Case presentation 44-year-old TAPVR patient admitted to our medical center. A snowman-shaped heart, including cardiomegaly and an increase in pulmonary blood flow, was seen in the chest X-ray. A large-sized (around 3 cm) atrial septal defect with dilated right atrium, right ventricle, and pulmonary artery was detected on echocardiography. Heart computed tomography was performed for further evaluation, and supra-cardiac type TAPVR without any obstructive lesion was identified. Conclusions TAPVR in an adult patient is extremely rare, and this patient was treated successfully with surgical correction and is doing well. A sinus rhythm and mild mitral valve regurgitation have remained during 2.5 years of outpatient follow-up.
Collapse
Affiliation(s)
- Yohan Bae
- Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| | - Woo Sung Jang
- Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
| | - Kyungsub Song
- Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| |
Collapse
|
4
|
Cervantes-Salazar JL, Calderón-Colmenero J, Martínez-Guzmán A, García-Montes JA, Rivera-Buendía F, Ortega-Zhindón DB. Total anomalous pulmonary venous connection: 16 years of surgical results in a single center. J Card Surg 2022; 37:2980-2987. [PMID: 35726661 DOI: 10.1111/jocs.16699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the study was to analyze the surgical outcome of patients with total anomalous pulmonary venous connection (TAPVC) who underwent cardiac surgery. METHODS A retrospective study was carried out. Patients with diagnosis of TAPVC undergoing cardiac surgery at the National Institute of Cardiology Ignacio Chávez, from January 1, 2003 and June 30, 2019 were included. Descriptive statistics were calculated, as well as a bivariate analysis of the variables associated with mortality. A logistic regression model was included to determine risk factors associated with the main outcome and survival was analyzed using the Kaplan-Meier method. RESULTS A total of 5314 patients diagnosed with congenital heart disease (CHD) underwent surgery, 414 (7.8%) were patients with TAPVC, with an average age of 17.1 ± 34.6 months, 58.2% were male. It was frequent in infants (61.6%) and preschool (19.6%). Predominant type was supracardiac TAPVC (47.4%). Pulmonary venous obstruction (PVO) occurred in 32.1%. Risk factors associated with mortality were infracardiac TAPVC (odds ratio [OR]: 3.26; 95% confidence interval [CI]: 1.17-9.03; p = .02), PVO (OR: 2.56; 95% CI: 1.05-6.22; p = .03) and postoperative mechanical ventilation (OR: 1.005; 95% CI: 1.002-1.008; p = .01). Overall survival was 87.2%, with better outcomes in adolescents (100%), children (94.1%), mixed TAPVC (96%), and cardiac TAPVC (91.9%; p < .001). CONCLUSIONS The survival of our institution after surgical correction of TAPVC is similar to that of other referral centers, where patients with infracardiac TAPVC and newborns worse outcomes. All patients must undergo a rigorous evaluation to determine an adequate repair strategy.
Collapse
Affiliation(s)
- Jorge L Cervantes-Salazar
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Juan Calderón-Colmenero
- Department of Pediatric Cardiology, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Andrés Martínez-Guzmán
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - José A García-Montes
- Department of Interventional Cardiology in Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Frida Rivera-Buendía
- Department of Clinical Research, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Diego B Ortega-Zhindón
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| |
Collapse
|
5
|
Palaparthi S, Jagannath BR, Shastri R, Jayanthi K, Rao NK, Vyas S, Inguava S, Shekhada N, Siva Sai Kiran KVS, Mannam G. Predictors of mortality and morbidity in total anomalous pulmonary venous connection with biventricular physiology: A 10-year Indian single centre experience of 492 patients. Ann Pediatr Cardiol 2022; 15:229-237. [PMID: 36589652 PMCID: PMC9802617 DOI: 10.4103/apc.apc_104_21] [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] [Received: 05/26/2021] [Revised: 10/17/2021] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Surgical correction of total anomalous pulmonary venous connection (TAPVC) remains associated with significant mortality despite advances in intra-operative and postoperative management. We retrospectively analyzed 492 consecutive TAPVC patients with biventricular physiology, who were operated at our centre, with regard to predictors of mortality, morbidity, and intermediate-term outcomes. Materials and Methods A total of 492 TAPVC patients with biventricular physiology were operated at our centre from August 2009 to November 2019. Their medical records were reviewed and were followed up during March-April 2020 for any symptoms of cardiac disease. Results Of 492, 302 (61.38%) were healthy at follow-up, 29 (5.89%) had postoperative mortality, 23 (4.67%) had mortality during the follow-up period, and 138 (28.05%) were lost to follow up. Age <1 month and weight <2.5 kg were associated with higher mortality with odds ratios (OR) of 6.37 and 5.56, respectively. There was no difference in mortality in different types of TAPVC. Obstructed TAPVC was associated with higher mortality with OR of 3.05. Acute kidney injury requiring peritoneal dialysis and sepsis were associated with higher mortality with ORs of 10.17 and 3.29, respectively. All follow-up mortality occurred in <1 year from the index operation. Anastomotic gradients were significantly higher in patients who died. Conclusions Although peri-operative TAPVC mortality has reduced, mortality on follow-up continues to occur and is partly due to the obstruction of pulmonary venous pathway. Meticulous follow-up holds the key in further reducing the mortality. Larger studies are needed for the identification of risk factors for pulmonary venous obstruction and its preventive strategies.
Collapse
Affiliation(s)
- Sairam Palaparthi
- Department of Cardiothoracic Surgery, Star Hospitals, Hyderabad, Telangana, India
| | | | - Ramkinkar Shastri
- Department of Anesthesiology, Star Hospitals, Hyderabad, Telangana, India
| | - Kishore Jayanthi
- Department of Paediatrics, Star Hospitals, Hyderabad, Telangana, India
| | - Nitin Krishna Rao
- Department of Paediatric Cardiology, Star Hospitals, Hyderabad, Telangana, India
| | - Suman Vyas
- Department of Paediatric Cardiology, Star Hospitals, Hyderabad, Telangana, India
| | - Savitri Inguava
- Department of Anesthesiology, Star Hospitals, Hyderabad, Telangana, India
| | - Nikunj Shekhada
- Department of Cardiothoracic Surgery, Star Hospitals, Hyderabad, Telangana, India
| | | | - Gopichand Mannam
- Department of Cardiothoracic Surgery, Star Hospitals, Hyderabad, Telangana, India
| |
Collapse
|
6
|
Chowdhury UK, Anderson RH, Spicer DE, Sankhyan LK, Pandey NN, Goja S, Rajasekar P, Arvind B, Pradeep D. Surgical management of hearts with isomeric atrial appendages. J Card Surg 2022; 37:1340-1352. [PMID: 35122446 DOI: 10.1111/jocs.16268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM On the basis of previously published accounts, coupled with our own experience, we have assessed the surgical approaches to patients with isomeric atrial appendages. METHODS We reviewed pertinent published studies on surgical treatment of individuals with isomeric atrial appendages, with the pertinent surgical details provided by most of the manuscripts. RESULTS Half of patients with right isomerism, and two-thirds of those with left isomerism have bilateral superior caval veins. Azygos extension of the inferior caval vein is reported in three-quarters of those with left isomerism. The coronary sinus is universally absent in right isomerism, along with totally anomalous pulmonary venous connection, and is absent in two-fifths of those with left isomerism. Univentricular atrioventricular connections are expected in up to three-quarters of those with right isomerism. Atrioventricular septal defect is reported in up to four-fifths, more frequently in right isomerism, with such patients typically having discordant ventriculoatrial connections or double outlet right ventricle. Reported mortalities extend to 85% for those with right, and 50% for those with left isomerism. In right isomerism, mortality is up to 54% for systemic-to-pulmonary arterial shunting, up to 75% for univentricular repair, and up to 95% for repair of totally anomalous pulmonary venous connection itself. No more than one-quarter had undergone Fontan completion, with reported mortalities of 21%. CONCLUSION Early surgical results are satisfactory in patients with left isomerism, but disappointing for those with right. Recent advances in cardiac and liver transplantation may offer improved survival.
Collapse
Affiliation(s)
- Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Department of Pediatric Cardiology, University of Florida, Gainesville, Florida, USA
| | - Lakshmi K Sankhyan
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bilaspur, India
| | - Niraj N Pandey
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajasekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Doniparthi Pradeep
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
Ji E, Qiu H, Liu X, Xie W, Liufu R, Liu T, Chen J, Wen S, Li X, Cen J, Zhuang J. The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates-10-Year Experience at a Single Center. Front Cardiovasc Med 2021; 8:775578. [PMID: 34869690 PMCID: PMC8632761 DOI: 10.3389/fcvm.2021.775578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following repair of total anomalous pulmonary venous connection (TAPVC). However, surgical repair of neonatal TAPVC remains associated with a high risk of postoperative mortality and pulmonary venous obstruction (PVO). We conducted this retrospective study to identify risk factors associated with surgical outcomes in the neonatal population. Methods: A retrospective review was conducted for all 127 neonates who underwent operations for isolated TAPVC from January 2009 to January 2019. Results: Preoperative PVO occurred in 33 (26.0%) of the 127 patients. Fifty patients (39.4%) required tracheal intubation before the operation. Twenty-three patients (18.1%) underwent emergency surgery. There were 11 (8.7%) early deaths. Significant risk factors were prolonged cardiopulmonary bypass (CPB) time (p = 0.013) and increased postoperative central venous pressure (CVP, p = 0.036). There were 5 (4.3%) late deaths within 1 year of repair. The risk factors for overall death were preoperative acidosis (p = 0.001), prolonged CPB time (p < 0.001) and increased postoperative CVP (p = 0.007). In particular, mortality was significantly higher (p = 0.007) with a postoperative CVP > 8 mmHg. With an increase in use of sutureless techniques (p = 0.001) and decrease in deep hypothermic circulatory arrest (p = 0.009) over the past 5 years, postoperative mortality greatly decreased (21.2%: 6.7%, p = 0.016). Postoperative PVO occurred in 15 patients (11.8%). Risk factors were mixed TAPVC (p = 0.037), preoperative acidosis (p = 0.001) and prolonged CPB time (p = 0.006). Conclusion: Although postoperative mortality of neonatal TAPVC has dropped to 6.7% over the past 5 years, it is still relatively high. Risk factors for postoperative death include preoperative acidosis, prolonged CPB time and increased postoperative CVP. Mortality was significantly higher for neonates with an average CVP > 8 mmHg 24 h after surgery.
Collapse
Affiliation(s)
- Erchao Ji
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Hailong Qiu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaobing Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen Xie
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rong Liufu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Liu
- Department of Biostatistics School of Public Health, Brown University, Providence, RI, United States
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohua Li
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianzheng Cen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
8
|
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
|
9
|
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
|
10
|
Ferrero P, Piazza I, Koneti NR, Ciuffreda M. Catheter closure of a patent vertical vein after repair of an unusual total anomalous variant of pulmonary venous drainage. Ann Pediatr Cardiol 2020; 14:82-84. [PMID: 33679067 PMCID: PMC7918028 DOI: 10.4103/apc.apc_139_19] [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] [Received: 09/28/2019] [Revised: 02/24/2020] [Accepted: 09/17/2020] [Indexed: 12/04/2022] Open
Abstract
Total anomalous pulmonary venous drainage (TAPVD) encompasses a wide spectrum of anatomical variants. The infradiaphragmatic type is almost always obstructive owing to the interposition of intrahepatic resistances; since almost invariable, the vertical vein inserts on the portal venous system. On correction of this variant, the vertical vein might not be ligated to avoid postoperative pulmonary hypertension. We hereby describe an unusual case of infradiaphragmatic TAPVD, with a vertical vein connected to ductus venosus. Since vertical vein was not ligated, it realized an unrestrictive pathway between the left atrium and the suprahepatic veins which resulted in persistent chylous peritoneal drainage. The patient successfully underwent catheter occlusion of the vertical vein which led to complete resolution of the clinical picture.
Collapse
Affiliation(s)
- Paolo Ferrero
- Cardiovascular Department, Division of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Isabelle Piazza
- Cardiovascular Department, Division of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Nageswara Rao Koneti
- Department of Pediatric Cardiology, Rainbow Children Heart Hospitals, Hyderabad, Telangana, India
| | - Matteo Ciuffreda
- Cardiovascular Department, Division of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
11
|
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
|
12
|
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
|
13
|
Talwar S, Arora Y, Gupta SK, Kothari SS, Ramakrishnan S, Saxena A, Choudhary SK. Total Anomalous Pulmonary Venous Connection Beyond the First Decade of Life. World J Pediatr Congenit Heart Surg 2019; 10:185-191. [PMID: 30841831 DOI: 10.1177/2150135118822792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We report our experience with surgery for total anomalous pulmonary venous connection (TAPVC) beyond first decade of life. METHODS Between January 1987 and July 2017, 98 patients ≥ten years underwent TAPVC repair. Their detailed case-records were analyzed. RESULTS Mean age was 19.05 (± 12.8; median 18) years. Anatomic subtypes were supracardiac (n = 62), cardiac (n = 20), and mixed (n = 16). An atrial septal defect (ASD) was present in all. Severe tricuspid valve regurgitation was present in four patients and severe rheumatic mitral regurgitation was present in one. On preoperative cardiac catheterization, mean pulmonary artery pressure was 67 ± 15.6 mm Hg (median 58; range 37-96). Mean pulmonary vascular resistance was 5.6 ± 3.9 Woods units·m2 (median 4.7, range 2.9-11.8). Twenty-five patients had moderate and eight had severe pulmonary arterial hypertension. Right ventricular dysfunction was present in eight patients. At repair, a small ASD was left open in 87 patients while in 11 patients, the ASD was closed using a unidirectional valved patch. Follow-up was available for 90 (92%) patients. There were no late deaths over a mean follow-up of 163 ± 103.98 months (median 163, range 1-362). Eighty-two patients were in NYHA class I and eight were in class II. Right ventricular function normalized in 82 patients while 80 patients had reduction in pulmonary artery pressure. Event-free survival was 94.2% at 5 years, 92.3% at 10 years, and 90% at 20 and 30 years. CONCLUSIONS Outcomes of surgical repair for TAPVC beyond first decade of life are satisfactory. Close follow-up, however, is necessary for possible persistence of pulmonary arterial hypertension.
Collapse
Affiliation(s)
- Sachin Talwar
- 1 Departments of Cardiothoracic and Vascular Surgery, Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Arora
- 1 Departments of Cardiothoracic and Vascular Surgery, Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- 2 Departments of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- 2 Departments of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anita Saxena
- 2 Departments of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- 1 Departments of Cardiothoracic and Vascular Surgery, Cardiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
14
|
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
|
15
|
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
|
16
|
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
|
17
|
The research on operation of obstructed total anomalous pulmonary venous connection in neonates. ScientificWorldJournal 2014; 2014:576569. [PMID: 25089291 PMCID: PMC4099118 DOI: 10.1155/2014/576569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/16/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives. Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease. This study aimed to evaluate the outcomes of TAPVC repair in neonates, controlling for anatomic subtypes and surgical techniques. Methods. Between 1997 and 2013, 88 patients (median age: 16 days) underwent repair for supracardiac (31), cardiac (18), infracardiac (36), or mixed (3) TAPVC. All the patients underwent emergency operation due to obstructed drainage. Supracardiac and infracardiac TAPVC repair included a side-to-side anastomosis between the pulmonary venous confluence and left atrium. Coronary sinus unroofing was preferred for cardiac TAPVC repair. Results. The early mortality rate was 2.3% (2/88 patients). The echocardiogram showed no obstruction in the pulmonary vein anastomosis, and flow rate was 1.1–1.42 m/s in the 3-year follow-up period. Conclusions. The accurate preoperative diagnosis, improved protection of heart function, use of pulmonary vein tissue to anastomose and avoid damage of the pulmonary vein, and delayed sternum closure can reduce the risk of mortality. The preoperative severity of pulmonary vein obstruction, the timing of the emergency operation, and infracardiac or mixed-type TAPVC can affect prognosis. Using our surgical technique, the TAPVC mortality among our patients was gradually reduced with remarkable results. However, careful monitoring of the patient with pulmonary vein restenosis and the timing and method of reoperation should also be given importance.
Collapse
|
18
|
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
|
19
|
Marcondes LD, Galati JC, Jones BO, Konstantinov IE, d’Udekem Y, Brizard CP, Cheung MM. Abnormal left ventricular diastolic function at late follow-up after repair of total anomalous pulmonary venous drainage: The impact of altered ventricular loading in utero. J Thorac Cardiovasc Surg 2014; 148:238-44. [DOI: 10.1016/j.jtcvs.2013.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 07/24/2013] [Accepted: 08/16/2013] [Indexed: 11/30/2022]
|
20
|
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]
|
21
|
Carvajal-Kalil L, Zapata-Sánchez M, Guzmán-Bustamante M, Ruz-Montes M, Donado-Perna J, Lince-Varela R, Díaz-Medina L. [Endovascular occlusion of the vertical vein with an Amplatzer®Vascular Plug. Case report]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:31-4. [PMID: 23433582 DOI: 10.1016/j.acmx.2013.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 12/28/2012] [Accepted: 01/09/2013] [Indexed: 11/16/2022] Open
Abstract
The use of the Amplatzer®Vascular Plug has diversified and has been described successfully in different clinical settings. We describe another application for this device, presenting the case of a patient with a history of correction of total anomalous connection of pulmonary veins, who underwent occlusion of the unligated vertical vein with the Amplatzer®Vascular Plug.
Collapse
Affiliation(s)
- Luis Carvajal-Kalil
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia.
| | | | | | | | | | | | | |
Collapse
|
22
|
Hote MP, Garg S, Choudhury M, Raghu MG. Open vertical vein in non-obstructed supracardiac TAPVC: merits and fate. Asian Cardiovasc Thorac Ann 2012; 20:114-9. [PMID: 22499955 DOI: 10.1177/0218492311433776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data of 18 patients who underwent surgical repair of non-obstructed supracardiac total anomalous pulmonary venous connection between January 2007 and March 2011 were reviewed. The vertical vein was left patent in all patients as an elective surgical strategy. There was no operative mortality in patients with or without preoperative pulmonary infection, but there were significant differences in postoperative airway pressures, ventilation time, intensive care unit and hospital stay between the 2 groups. None of the patients demonstrated any flow in the vertical vein over a 30-day follow-up period. One patient had a mild anastomotic stricture and pulmonary venous hypoplasia. Operative repair of supracardiac total anomalous pulmonary venous connection can be carried out successfully without ligation of the vertical vein, and this strategy possibly reduces early postoperative morbidity and mortality, with no adverse effects detected in the short to midterm follow-up.
Collapse
Affiliation(s)
- Milind Padmakar Hote
- Departmant of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | | | | | | |
Collapse
|
23
|
Karaci AR, Harmandar B, Aydemir NA, Sasmazel A, Balci AY, Saritas T, Yekeler I, Bilal MS. Early and intermediate term results for surgical correction of total anomalous pulmonary venous connection. J Card Surg 2012; 27:376-80. [PMID: 22497245 DOI: 10.1111/j.1540-8191.2012.01435.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This retrospective study evaluated factors associated with mortality and morbidity in patients having functionally biventricular heart (FBH) and functionally univentricular heart (FUH) undergoing total anomalous pulmonary venous connection (TAPVC) repair. METHODS We reviewed medical records retrospectively and identified 72 patients undergoing TAPVC repair between July 2002 and December 2010; and 62 patients had FBH and 10 patients had FUH. The median age and weight at repair was 9.1 months (range, 8 days-16 years) and 6.7 kg (range, 2.5-57 kg). The TAPVC anatomy was supracardiac in 41 (56.9%), cardiac in 18 (25%), infracardiac in eight (11.1%), and mixed in five patients (6.9%). RESULTS There were seven early deaths (2 FBH [25%] and 5 FUH [62.5%]) and one late death (FUH). Presence of FUH (p < 0.01), heterotaxy syndrome (p = 0.03), young age (p < 0.01), low weight (p < 0.01) and long CPB time (p = 0.04) at the time of surgery were statistically significant risk factors for mortality. Morbidity was related to long duration of postoperative mechanical ventilation, intensive care unit and hospital stay. Presence of FUH was the only significant risk factor for morbidity (p < 0.01). After a mean follow-up of 52.1 months (range, 3-74 months), 59 (92%) of 64 survivors were asymptomatic without any medication, and five have mild symptoms with regular physical activity. CONCLUSION Operative results of TAPVC have dramatically improved in recent years. However, patients having FUH (especially with concomitant palliative surgery), heterotaxy syndrome, low weight, early age, and long CPB time still have an increased operative mortality.
Collapse
Affiliation(s)
- Ali Riza Karaci
- Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Kobayashi D, Forbes TJ, Delius RE, Aggarwal S. Amplatzer vascular plug for transcatheter closure of persistent unligated vertical vein after repair of infracardiac total anomalous pulmonary venous connection. Catheter Cardiovasc Interv 2012; 80:192-8. [PMID: 22422595 DOI: 10.1002/ccd.23497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 11/21/2011] [Indexed: 11/12/2022]
Abstract
Repair of total anomalous pulmonary venous connection (TAPVC) involves anastomosing the pulmonary venous confluence with the left atrium and ligating the vertical vein. Sometimes, the vertical vein needs to be left open as a pop off with the idea that it will close over time. Infrequently an unligated vertical vein may remain patent after repair of infaracardiac TAPVC leading to hemodynamic instability. We report an infant in whom an unligated vertical vein remained patent after the repair of infracardiac TAPVC and caused hemodynamically significant left-to-right shunting. A successful transcatheter closure of persistent patent unligated vertical vein was performed using the Amplatzer Vascular Plug-I device.
Collapse
Affiliation(s)
- Daisuke Kobayashi
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201-2119, USA.
| | | | | | | |
Collapse
|
25
|
Outcomes of Surgery for Simple Total Anomalous Pulmonary Venous Drainage in Neonates. Ann Thorac Surg 2011; 91:1921-7. [DOI: 10.1016/j.athoracsur.2010.12.069] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Revised: 12/10/2010] [Accepted: 12/16/2010] [Indexed: 11/18/2022]
|
26
|
Chen H, Xu Z. Outcome of primary repair of infracardiac total anomalous pulmonary venous connection using a right-sided approach to the left atrium. J Card Surg 2010; 26:102-6. [PMID: 21158917 DOI: 10.1111/j.1540-8191.2010.01170.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pulmonary venous obstruction (PVO), the major postoperative complication in patients with infracardiac total anomalous venous connection (TAPVC), compromises the surgical outcomes of TAPVC repair. Here, we report our experience using a right-sided approach to the left atrium to repair this anomaly variant. METHOD Eleven patients with infracardiac TAPVC underwent this surgical modification from September 2005 to December 2009. After a medium sternotomy, bicaval venous cannulation was performed for cardiopulmonary bypass (CPB). By adequate exposure of the surgical field, incision of the left atrium was located and anastomosed to the corresponding incision in the pulmonary venous confluence through the right side. Medical records consisting of preoperative and postoperative data were retrospectively reviewed to analyze the efficiency of this strategy. RESULTS Total correction was achieved in all 11 patients and there were no operative deaths. Postoperative low cardiac output persisted in six patients (54.5%), including five patients with preoperative PVO. No late deaths were noted in a mean follow-up of 26.7 months (range, 1 to 51 months). Both residual atrial shunt and severe anastomotic obstruction were excluded by transthoracic echocardiography. Moderate residual obstruction was confirmed in one patient. At the end of the follow-up, all patients had normal biventricular function and were in New York Heart Association (NYHA) Functional Class I. CONCLUSION The right-sided approach for repair of infracardiac TAPVC contributes to produce favorable outcomes. This modified technique is useful for enhancing exposure during surgical repair and providing adequate patent anastomosis.
Collapse
Affiliation(s)
- Hao Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | |
Collapse
|
27
|
Frommelt PC, Sheridan DC, Deatsman S, Yan K, Simpson P, Frommelt MA, Litwin SB, Tweddell JS. Unobstructive total anomalous pulmonary venous return: impact of early elective repair on the need for prolonged mechanical ventilatory support. Pediatr Cardiol 2010; 31:1191-7. [PMID: 20848277 DOI: 10.1007/s00246-010-9788-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 08/17/2010] [Indexed: 11/30/2022]
Abstract
Optimal timing for elective repair of total anomalous pulmonary venous return (TAPVR) in the case of an unobstructed anomalous pathway is unclear. All infants with a diagnosis of TAPVR as an isolated lesion who underwent surgical repair at Children's Hospital of Wisconsin from 1991 to 2007 were reviewed to assess location of drainage, presence of obstruction, age at presentation, age at surgery, death, need for extracorporeal membrane oxygenation (ECMO), length of hospital stay, length of mechanical ventilation (MV), and late pulmonary venous obstruction. A total of 65 patients were identified: 38 (59%) with supracardiac drainage, 10 (15%) with cardiac drainage, 11 (17%) with infracardiac drainage, and 6 (9%) with mixed drainage. For 39 (60%) of the 65 patients, obstruction was identified preoperatively. Three early and five late deaths occurred after surgery (12%), all involving patients with preoperative obstruction. Most of the late deaths (80%) involved patients who experienced recurrent obstruction. Of the 65 patients, 26 (40%) had no obstruction preoperatively, and none died, required ECMO support, or experienced late obstruction. For the 26 patients without obstruction, the timing of surgery was elective at the discretion of the supervising cardiologist. Among these 26 patients, 15 had surgery less than 10 days after presentation (median age, 18 days), and 53% of these 15 patients (8/15) had MV less than 5 days. In contrast, all 11 patients who had elective surgery more than 10 days after presentation (median age, 56 days) required MV for more than 5 days (p = 0.007). Isolated TAPVR appears to be at the highest risk for death and late postoperative obstruction when obstruction is present preoperatively. Patients with unobstructive TAPVR do very well, but potential morbidity related to prolonged MV appears to be significantly reduced by early elective surgery.
Collapse
Affiliation(s)
- Peter C Frommelt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Total anomalous pulmonary venous connection: Results of surgical repair of 100 patients at a single institution. J Thorac Cardiovasc Surg 2010; 139:1387-1394.e3. [DOI: 10.1016/j.jtcvs.2010.02.024] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 12/08/2009] [Accepted: 02/08/2010] [Indexed: 11/21/2022]
|
29
|
Koshy T, Tambe SP, Sinha PK, Karmarkar V, Bhupali AN, Tempe DK, Koch CG. Case 2--2008 rheumatic mitral stenosis associated with partial anomalous pulmonary venous return. J Cardiothorac Vasc Anesth 2008; 22:302-10. [PMID: 18375340 DOI: 10.1053/j.jvca.2007.12.006] [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: 12/07/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas Koshy
- Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
| | | | | | | | | | | | | |
Collapse
|
30
|
Chowdhury UK, Mishra A, Saxena A, Kothari SS, Malhotra A, Mahajan R, Honnakere JHV, Venugopal P. A novel percutaneously adjustable device for ligature of the vertical vein in the setting of obstructive totally anomalous pulmonary venous connection. Cardiol Young 2007; 17:380-6. [PMID: 17572928 DOI: 10.1017/s104795110700087x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A patent vertical vein might be desirable in patients with obstructive totally anomalous pulmonary venous connection with pulmonary hypertension, in order to decrease perioperative pulmonary arterial pressure and avoid pulmonary hypertensive crises. A subset of patients with an unligated vertical vein requires interruption of the vein due to the development of significant left-to-right shunt and right heart failure. We describe here a new device, permitting adjustable ligation of the vertical vein, which permits us to avoid multiple reoperations. PATIENTS AND METHODS In five patients, aged 2, 4, 3, 4, and 3 months respectively, and undergoing rechannelling of totally anomalous pulmonary venous connection with an unligated vertical vein, were treated with a device permitting adjusted ligation of the vertical vein over the course of postoperative congestive cardiac failure. RESULTS There was no early or late death. Postoperatively, all ligatures were tightened gradually over a period of 24 to 96 hours, maintaining stable haemodynamics. At a mean follow-up of 55.40 months, there was no evidence of congestive heart failure in any patient, the clinical risk score varying from zero to 2, and no requirement of anti-failure medications. Computed tomographic angiograms during follow-up revealed absence of flow through the vertical vein, and ruled out distortion of the left upper pulmonary and left brachiocephalic veins. CONCLUSION Use of a percutaneously adjustable device to ligate the vertical vein allows gradual tightening or loosening of the ligature under optimal physiologic conditions, without re-opening the sternum, or having to resort to another thoracotomy once the reactive components of pulmonary hypertension disappear.
Collapse
Affiliation(s)
- Ujjwal K Chowdhury
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Tweddell JS. The vertical vein: to ligate or not to ligate. J Thorac Cardiovasc Surg 2007; 133:1135-6. [PMID: 17467419 DOI: 10.1016/j.jtcvs.2006.09.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 09/28/2006] [Indexed: 10/23/2022]
|