Total Anomalous Pulmonary Venous Connection

Factors associated with early postoperative mortality after total anomalous pulmonary venous connection repair: A retrospective cohort study

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital defect where pulmonary venous plexus fails to connect with the left atrium (LA). Surgical repair is the primary treatment for TAPVC, but factors influencing outcomes are not fully understood. This study investigates the early outcomes of surgical repair for TAPVC and associated factors. A retrospective cohort analysis was conducted on TAPVC patients who underwent surgical repair between 2012 and 2022. Data were collected from medical records and supplemented with phone call validation. Demographic characteristics, surgical data, diagnostic tests, and outcomes were analyzed. Statistical analysis included chi-square, t-tests, and multivariate logistic regression using SPSS. A total of 88 patients underwent surgical repair for TAPVC, resulting in a mortality rate of 21.6%. Weight and bypass time were significantly associated with patient survival. Female patients had a higher likelihood of death. The anatomic type did not significantly influence mortality. Patients with pulmonary venous obstruction (PVO) experienced a higher mortality rate. Notably, ligation of the vertical vein in supracardiac and infracardiac types was associated with lower mortality. In conclusion, our study identifies several key factors contributing to higher mortality rates following TAPVC surgery, including low weight, female gender, prolonged bypass time, and preoperative vein obstruction. Highlighting the significance of surgical technique, particularly the sutureless approach, we advocate for its meticulous consideration to achieve improved outcomes. Furthermore, our findings indicate a potential decrease in mortality associated with vertical vein ligation, which may mitigate the risk of post-repair heart failure. We suggest further rigorous studies to gain comprehensive insights into TAPVC surgical interventions.

Multidetector Computed Tomography (MDCT) Angiography Evaluation of Total Anomalous Pulmonary Venous Connection

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiovascular malformation in which all four pulmonary veins anomalously drain into the right atrium (RA) either directly or indirectly. There are four main types based on the site of connection. Any type of TAPVC may be associated with obstruction and presents early in the neonatal period with cyanosis, tachycardia, or respiratory distress. We present four cases of all types of TAPVC and its imaging findings in multidetector computed tomography (MDCT) angiography. Cardiac CT and magnetic resonance imaging (MRI) are very useful in delineating the anatomy and drainage pathway of anomalous pulmonary veins. MDCT angiography is noninvasive and easily available, and rapid image acquisition is possible with high spatial resolution. Since early diagnosis and surgical correction are necessary for the survival of these neonates, rapid image acquisition using MDCT angiography can be preferred over MRI.

Anomalous venoatrial connections - CT and MRI assessment

Abnormal venous atrial (VA) connections present a congenital heart disease (CHD) challenge for pediatric cardiologists. Fully anatomical evaluation is very difficult in prenatal and perinatal follow-up, but it has a profound impact on surgical correction and outcome. The echocardiogram is first-line imaging and represents the gold standard tool for simple abnormal VA connection. CT and MRI are mandatory for more complex heart disease and "nightmare cases". 3D post-processing of volumetric CT and MRI acquisition helps to clarify anatomical relationships and allows for the creation of 3D printing models that can become crucial in customizing surgical strategy. Our article describes a ten-year (2013-2022) tertiary referral CHD center of abnormal AV connections investigated with CT and MRI, illustrating most of these complex diseases with the help of volume rendering (VR) or multiplanar reconstructions (MPR). The nightmarish cases will also be addressed due to the complex cardiovascular arrangement that requires a challenging surgical solution for correction along with the post-surgical complications.

Echocardiographic evaluation of total anomalous pulmonary venous connection: Comparison of obstructed and unobstructed type

This study aims to compare the differences between obstructed and unobstructed total anomalous pulmonary venous connection (TAPVC) using echocardiography, and to evaluate the clinical and echocardiographic parameters associated with pulmonary venous obstruction (PVO).We conducted a retrospective study of 70 patients with TAPVC between 2014 and 2019. The morphologic and hemodynamic echocardiographic parameters of patients were observed and measured, and the parameters between obstructed and unobstructed TAPVC were compared. The clinical and echocardiographic parameter differences between the two groups were used for ROC curve analysis.Obstructed TAPVC was found in 30 (42.9%) of 70 patients. Between obstructed and unobstructed TAPVC, there were significant differences in atrial septal defect size, pulmonary artery maximum velocity (PA Vmax ), peak E velocity of mitral valve, left ventricular fractional shortening, left ventricular ejection fraction, stroke volume and the incidence of patent ductus arteriosus, but there was no significant difference in birth weight. The first diagnosis age of obstructed TAPVC was earlier than unobstructed type. The ROC curve analysis for the first diagnosis age showed the sensitivity and specificity were 76.7%, 80% respectively. The ROC curve analysis for the PA Vmax showed the sensitivity and specificity were 88.5%, 67.6% respectively.Patients with TAPVC had a high incidence of PVO. The presence of PVO can affect the size of atrial septal defect and the closure of the ductus arteriosus, cause significant changes in PA Vmax, peak E velocity of mitral valve, left ventricular fractional shortening, left ventricular ejection fraction, stroke volume, lead to earlier symptoms and earlier first diagnosis age. The first diagnosis age and PA Vmax were excellent values since they associated with PVO.

Computed tomography findings and preoperative risk factors for mortality of total anomalous pulmonary venous connection

Detailed preoperative imaging of total anomalous pulmonary venous connection (TAPVC) is critical to ensuring adequate surgical planning and preoperative decision making. The purpose of this study was to describe the computed tomography findings of TAPVC and identify morphologic death risk factors. We conducted a retrospective study included 70 patients with TAPVC between May 2014 and June 2017 in Hunan Children's Hospital. All available clinical data and computed tomography imaging were reviewed, and survival time was followed-up. Life Tables analysis was used to estimate survival rates. Patient survival was described with Kaplan-Meier curves. Cox Regression model was used to test the potential risk factors. TAPVC was subdivided into four types. Of 70 cases, 42 (60%) had supracardiac, 13 (18.6%) had cardiac, 8 (11.4%) had infracardiac, and 7 (10%) had mixed type. Pulmonary venous obstruction (PVO) was found in 30 (42.9%) of 70 patients in this group. Of all concurrent abnormalities, atrial septal defect (ASD) was the most common (98.6%), followed by patent ductus arteriosus (PDA; 31, 44.3%), and persistent left superior vena cava (PLSVC; 5, 7.1%). 1, 3, 6 and 12-month survival rates were 76, 61, 49, and 38% respectively. Risk factors for mortality in multivariable analysis comprised PVO, McGoon index (MGI), and mode of delivery. Various concurrent abnormalities and great morphological heterogeneity were observed in patients with TAPVC. Patients with TAPVC had a highest mortality in the neonatal period. PVO, smaller MGI and caesarean are important predictors for mortality.

Maternal Obesity as a Risk Factor for the Development of Total Anomalous Pulmonary Venous Connection in Their Offspring

The incidence of total anomalous pulmonary venous connection (TAPVC) in the Caucasian population is 2.5/100,000 live births (LB), and the incidence in the Hispanic population is 19.8/100,000 LB. Without knowing the exact etiology for the development of congenital heart disease, our objective was to determine the maternal factors associated with the development of TAPVC.

METHODS

55 mother-child binomials with isolated TAPVC (group I) and 152 healthy mother-child binomials (group II) were included. Both groups had no maternal history of addiction, pre-eclampsia, or type 1, 2 or gestational diabetes mellitus. Complete clinical histories were obtained for the women in both groups and perinatal and birth data were recorded. In addition, genealogies across three generations were constructed to determine affected first- or second-degree relatives with complex congenital heart disease.

RESULTS

Among the maternal characteristics analyzed, women in group I had a higher number of pregnancies before gestation of the index case (p = <0.05), and the Body Mass Index (BMI) before pregnancy was higher compared to Group II (p < 0.05), with an adjusted risk of OR = 3.6 (p = 0.011). The family history showed a higher prevalence in the group of patients with TAPVC compared to healthy children (p < 0.05).

CONCLUSION

Maternal obesity before pregnancy is a risk factor for the development of CATVP in children in the Mexican population.

Duplication and Deletion of 22q11 Associated with Anomalous Pulmonary Venous Connection

Anomalous pulmonary venous connection (APVC) is an uncommon congenital anomaly in which pulmonary venous blood flows directly into the right side of the heart or into the systemic veins. To identify whether there is any association between 22q11 CNVs and APVC, we analyzed the clinical data of 86 APVC patients and then studied the CNVs of 22q11 in 86 sporadic APVC patients by multiplex ligation-dependent probe amplification. The results showed that two patients carried the CNVs of 22q11, one patient had the deletion of 22q11 and the other had the duplication of 22q11. The incidence was significantly higher than that in the normal population (P < 0.01) that suggests a possible etiologic association between the duplication or deletion of 22q11 and the APVC in our patients.

Total Anomalous Pulmonary Venous Connection Draining into the Portal Vein in a 2-Month-Old Infant: Multidetector Computed Tomography Angiography Diagnosis

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac anomaly in which the pulmonary veins fail to connect with the left atrium and connect directly to the right atrium or to one of the systemic veins. Early diagnosis and surgical correction is highly important for survival. In the evaluation of TAPVC, imaging methods such as echocardiography, computed tomography (CT) angiography, magnetic resonance (MR) angiography, and catheter angiography have been used. We reported a rare case of infracardiac type of TAPVC draining into the portal vein at 2-mounth-old infant who was admitted to the hospital with shortness of breath and mild cyanosis. The images demonstrating TAPVC between the portal vein and the pulmonary veins with multidetector computed tomography (MDCT) angiography were also shown.

Early- and intermediate-term results of surgical correction in 122 patients with total anomalous pulmonary venous connection and biventricular physiology

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.

Role of plain radiography and CT angiography in the evaluation of obstructed total anomalous pulmonary venous connection

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.

Total anomalous pulmonary venous connection in a chicken

This report describes a case of total anomalous pulmonary venous connection (TAPVC) in a 5-wk-old male white leghorn chicken that presented with growth retardation. This chicken was a specific-pathogen-free chicken bred in an isolator. At 5 wk of age, the chicken was euthanatized and autopsied. Macroscopically, the right ventricle and right atrium were significantly enlarged whereas the left atrium was small and blind-ending with no connection to the pulmonary veins. The pulmonary veins were connected directly to the right atrium. The above abnormality was accompanied by an ostium secundum-type atrial septal defect. No other malformations were observed. TAPVC is a very rare congenital cardiac abnormality that has not been reported in avian species to date.

Cardiovascular MR imaging findings of total anomalous pulmonary venous connection to the portal vein in a patient with right atrial isomerism

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiovascular anomaly in which the pulmonary veins fail to join to the left atrium and drain directly to the right atrium or to one of the systemic veins. This anomaly is frequently seen together with complex cardiac anomalies especially as a part of right atrial isomerism syndrome. Atrial isomerism is called that the same morphological structure of both atria. We reported a very rare case demonstrating TAPVC between the portal vein and the pulmonary veins in a patient with right atrial isomerism by magnetic resonance imaging.

Congenital cardiac disease in the newborn infant: past, present, and future

Congenital heart defects are the most common of all congenital malformations, with a review of the literature reporting the incidence at 6 to 8 per 1000 live births. The Centers for Disease Control reports cyanotic heart defects occurred in 56.9 per 100,000 live births in the United States in 2005, with higher rates noted when maternal age exceeded 40 years. The incidence of congenital heart disease in premature infants is 12.5 per 1000 live births, excluding isolated patent ductus arteriosus and atrial septal defect. Despite advances in detection and treatment, congenital heart disease accounts for 3% of all infant deaths and 46% of death from congenital malformations. This article discusses the embryology, pathogenesis, clinical presentation, incidence, classifications, and management of congenital heart diseases.