1
|
Huang J, Tang J, Fan Y, Wang D, Ye L. Risk factors associated with prolonged intensive care unit stay following surgery for total anomalous pulmonary venous connection: a retrospective study. J Cardiothorac Surg 2023; 18:257. [PMID: 37689705 PMCID: PMC10492368 DOI: 10.1186/s13019-023-02356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/09/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Prolonged intensive care unit (ICU) stays consume medical resources and increase medical costs. This study identified risk factors associated with prolonged postoperative intensive care unit (ICU) stay in children with total anomalous pulmonary venous connection (TAPVC). METHODS The medical records of 85 patients who underwent surgical repair of TAPVC were retrospectively analyzed. The patients were divided into prolonged-stay and standard-stay groups. The prolonged stay group included all patients who exceeded the 75th percentile of the ICU stay duration, and the standard stay group included all remaining patients. The effects of patient variables on ICU stay duration were investigated using univariate and logistic regression analyses. RESULTS Patient median age was 41 (18-103) days, and median weight was 3.80 (3.30-5.35) kg.Postoperative duration of ICU stay was 11-68 days in the prolonged stay group (n = 23) and 2-10 days in the standard stay group (n = 62). Lower preoperative pulse oximetry saturation (SpO2), higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay. Preoperative SpO2 < 88.5%, highest plasma lactate value > 4.15 mmol/L, and postoperative mechanical ventilation duration was longer than 53.5 h, were associated with increased risk of prolonged ICU stay. Young age, low body weight, subcardiac type, need for vasoactive drug support, emergency surgery, long anesthesia time, low SpO2 after anesthesia induction, long cardiopulmonary bypass (CPB) and aortic clamp times, high lactate level, low temperature, large volume of ultrafiltration during CPB, large amounts of chest drainage, large red blood cells (RBCs) and plasma transfusion, and postoperative cardiac dysfunction may be associated with prolonged ICU stay. CONCLUSIONS Lower preoperative SpO2, higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When SpO2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 h, the risk of prolonged ICU stay increased. Improved clinical management, including early diagnosis and timely surgical intervention to reduce hypoxia time and protect intraoperative cardiac function, may reduce ICU stay time.
Collapse
Affiliation(s)
- Jinjin Huang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jian Tang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yong Fan
- Department of Extracorporeal Life Support, Heart Institute, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Dongpi Wang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lifen Ye
- Department of Extracorporeal Life Support, Heart Institute, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| |
Collapse
|
2
|
Yan L, Zhou Y, Li D, Li L, Tang H. Case report: Thoughts on two cases of total anomalous pulmonary venous connection complicated with pulmonary artery hypertension. Front Cardiovasc Med 2023; 10:1075168. [PMID: 36776261 PMCID: PMC9908588 DOI: 10.3389/fcvm.2023.1075168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023] Open
Abstract
The two primary pathological alterations of total anomalous pulmonary venous connection (TAPVC), a rare cyanotic congenital heart disease (CHD), are right heart failure and pulmonary artery hypertension (PAH). The timing and prognosis of surgery depend on the level of pulmonary hypertension. Surgery will not be an option after Eisenmenger syndrome appears. In light of this, it is crucial to assess patients' PAH. In order to aid in the following treatment of related types of diseases, this article studied and compared the echocardiographic features and disease development of one adult and one child TAPVC patients complicated with PAH.
Collapse
Affiliation(s)
- Ling Yan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaxin Zhou
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dayan Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lingli Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Hong Tang,
| |
Collapse
|
3
|
Rotar EP, Kron IL. Mixed type TAPVR-Measure twice, cut once. J Card Surg 2021; 36:2954-2955. [PMID: 34061393 DOI: 10.1111/jocs.15632] [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: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Total anomalous pulmonary venous return (TAVR) can have varying drainage configurations. Here, we review a report by Nagulakonda et al. to the Journal of Cardiac Surgery detailing how additional computed tomography imaging revealed a mixed type presentation of TAPVR not identified on echocardiography.
Collapse
Affiliation(s)
- Evan P Rotar
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Irving L Kron
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
4
|
Jaswal V, Thingnam SKS, Mishra AK, Mahajan S, Kumar V, Rohit MK, Mandal B. Mixed type total anomalous pulmonary venous connection: Early results and midterm outcomes of surgical correction. J Card Surg 2021; 36:1370-1375. [PMID: 33567115 DOI: 10.1111/jocs.15412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/11/2021] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY The morphological heterogeneity of anomalous pulmonary venous drainage in mixed type total anomalous pulmonary venous connection (TAPVC) has important implications in preoperative diagnosis and surgical repair resulting in high mortality in these patients. METHODS A retrospective review of 14 patients with mixed type TAPVC undergoing biventricular repair between January 2012 and December 2019 was conducted. A descriptive analysis was done, highlighting the anatomic variation, diagnostic and surgical approach, and surgical outcomes in these patients. RESULTS The most common anatomic pattern was "3 by 1" (79%) followed by "2 by 2" (21%). The correct diagnosis by transthoracic echocardiography was made in 10 (71%) of the 14 patients. In contrast, preoperative computed tomographic (CT) angiography was performed in 10 patients and correct diagnosis was obtained in 8 (80%) of them. Pulmonary venous obstruction was seen in one patient before surgery. The in-hospital mortality was 14% (2/14). Four patients had pulmonary hypertensive crisis in the postoperative period. The average follow-up was 54 ± 27 months (range: 17-98 months) after surgical repair, and all surviving patients were asymptomatic. There was no late death. No clinically apparent sequelae were seen in six patients in whom isolated left superior pulmonary vein drainage was left uncorrected. CONCLUSION An accurate diagnosis of anatomic pattern in mixed type TAPVC can be difficult to establish in all the patients before surgery. Detailed intraoperative assessment, individualized surgical approach, and aggressive perioperative management may reduce surgical mortality. Operative survivors have good midterm outcome.
Collapse
Affiliation(s)
- Vivek Jaswal
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam K S Thingnam
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand K Mishra
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Mahajan
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Kumar
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj K Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Banashree Mandal
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
5
|
Xiang M, Wu C, Pan Z, Wang Q, Xi L. Mixed type of total anomalous pulmonary venous connection: diagnosis, surgical approach and outcomes. J Cardiothorac Surg 2020; 15:293. [PMID: 33008456 PMCID: PMC7532098 DOI: 10.1186/s13019-020-01332-7] [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: 05/23/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To summarize the diagnosis and treatment of 13 patients with mixed-type total anomalous pulmonary venous connection (TAPVC) and propose another classification for mixed TAPVC. Methods A retrospective review of 13 patients with mixed TAPVC undergoing repair at a single institution was conducted between January 2010 and November 2019. The diagnosis of mixed-type TAPVC was made in all patients using echocardiography combined with computed tomography angiography. According to the mixed TAPVC anatomy, there were 3 patients with type I TAPVC (2 + 2 veins), 10 patients with type II TAPVC (3 + 1 veins) and no patients with type III TAPVC. Correspondingly, there was 1 patient with the “SVC + VV” subtype, 2 patients with the “CS + C” subtype, 8 patients with the “CS + VV” subtype, 1 patient with the “CS + SVC” subtype and 1 patient with the “RA + SVC” subtype according to our classification system. All patients underwent cardiopulmonary bypass surgery. Results The median weight at surgery was 4.6 ± 1.0 kg (3.4–7.3 kg), and the median age at surgery was 96.2 ± 81.2 days (10–242 days). The median cardiopulmonary bypass time was 132.7 ± 25.1 min (range, 100 to 190 min). The cross-clamping time was 69.2 ± 14.4 min (range, 45 to 88 min). The hospital mortality rate was 7.7% (1 of 13), with late mortality occurring in 1 patient because of pulmonary venous obstruction (PVO) 7 months after surgery. The average follow-up after surgery was 3.4 ± 2.2 years (range, 5 months to 8 years). The survival rates at 3 and 5 years were both 90.9% ± 8.7% (95% CI: 73.8–108%). All remaining surviving patients were asymptomatic. Conclusion Mixed TAPVC can be repaired with good results in children and can be correctly diagnosed with echocardiography combined with computed tomography angiography. The classification system we propose is pragmatic and can guide the surgical approach.
Collapse
Affiliation(s)
- Ming Xiang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorders(Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Chongqing Key Laboratory of Pediatrics, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorders(Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Chongqing Key Laboratory of Pediatrics, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorders(Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Chongqing Key Laboratory of Pediatrics, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Quan Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorders(Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Chongqing Key Laboratory of Pediatrics, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Linyun Xi
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,National Clinical Research Center for Child Health and Disorders(Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,Chongqing Key Laboratory of Pediatrics, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China.
| |
Collapse
|
6
|
Mehta A, Raju V, Muthukumaran S, Balakrishnan S, Muthuswamy K. Successful Surgical Management of a Rare Case of Mixed Type of Total Anomalous Pulmonary Venous Connection in a Very Low Birth Weight Preterm Child Using a Novel Surgical Technique. World J Pediatr Congenit Heart Surg 2019; 11:NP217-NP220. [PMID: 30654705 DOI: 10.1177/2150135118788779] [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: 11/17/2022]
Abstract
We report a rare case of combined supra- and infracardiac type of total anomalous pulmonary venous connection (mixed-type TAPVC) in a 26-day-old low birth weight (1.9 kg) infant who was admitted with respiratory distress. The child underwent successful surgical repair using a novel surgical technique and is doing well at one year follow-up.
Collapse
Affiliation(s)
- Anuj Mehta
- Division of Cardiothoracic Surgery, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Vijayakumar Raju
- Division of Cardiothoracic Surgery, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Subramanian Muthukumaran
- Division of Cardiothoracic Surgery, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | | | | |
Collapse
|
7
|
Zea-Vera R, Mery CM. Mixed Total Veins: The Epitome of the Few, the Disparate, and the Obscure. Semin Thorac Cardiovasc Surg 2017; 29:345-346. [PMID: 28935508 DOI: 10.1053/j.semtcvs.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Carlos M Mery
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
8
|
Clarke NS, Karamlou T, Vaughn G, Lamberti J, Murthy R. Mixed Total Anomalous Pulmonary Venous Return With Ascending and Descending Vertical Veins. World J Pediatr Congenit Heart Surg 2017; 8:633-634. [PMID: 28901227 DOI: 10.1177/2150135117717267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nicholas S Clarke
- 1 Division of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tara Karamlou
- 2 Division of Pediatric Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gabrielle Vaughn
- 3 Division of Pediatric Cardiology, Rady Children's Hospital, University of California, San Diego, CA, USA
| | - John Lamberti
- 4 Division of Pediatric Cardiothoracic Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA
| | - Raghav Murthy
- 4 Division of Pediatric Cardiothoracic Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA
| |
Collapse
|
9
|
Shim H, Yang JH, Jun TG. Two-stage correction of type IV total anomalous pulmonary venous connection. J Cardiothorac Surg 2017; 12:54. [PMID: 28683753 PMCID: PMC5501404 DOI: 10.1186/s13019-017-0617-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/21/2017] [Indexed: 11/24/2022] Open
Abstract
Background The small size of the pulmonary veins in infants increases the risk of pulmonary vein obstruction (PVO) after surgical repair of type IV total anomalous pulmonary venous connection (TAPVC). Here, we described the outcomes of our strategy, which delayed total correction after initial partial correction. Methods We reviewed the data of patients who underwent total correction for type IV TAPVC. In total, 11 out of 103 patients with TAPVC had type IV TAPVC with biventricular physiology. Of these 11 patients, we retrospectively reviewed the data of 7 patients who underwent two-stage correction. Major pulmonary venous confluent chambers, with the exception of the left superior pulmonary vein (LSPV), were initially anastomosed to the left atrium (LA), followed by anastomosis between the LSPV and the LA auricle. Results The median weight, age, and LSPV size were 4.3 kg (range, 3.5–5.4 kg), 40 days (range, 20–103 days), and 4.5 mm (range, 3.0–5.4 mm), respectively, during the first operation and 12.2 kg (range, 8.5–31.5 kg), 1,165 days (range, 280–3,250 days), and 9.8 mm (range, 8.0–12.3 mm), respectively, during the second operation. The median Qp/Qs was 1.61 (range, 1.22–1.65) and the median cardiothoracic ratio was 0.52 (range, 0.49–0.57) at second operation. The median interval between the operations was 1,094 days (range, 196–3,226 days). The median follow-up period was 22 month (range, 7–59 month). No mortality or major morbidities occurred after either operation. The median Vmax at the LSPV anastomosis site was 1.0 m/s (range, 0.8–1.3 m/s) on predischarge echocardiography. This patency was maintained at the last follow-up, showing an identical median Vmax of 1.0 m/s (range, 0.8–1.3 m/s). All 7 patients who underwent two-stage correction were in good condition, without any clinical symptoms of PVO. Conclusions Our results suggest that leaving the isolated LSPV uncorrected during infancy and performing a second operation when the LSPV has grown adequately is a viable treatment option for patients with type IV TAPVC.
Collapse
Affiliation(s)
- Hunbo Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| |
Collapse
|
10
|
St Louis JD, Turk EM, Jacobs JP, O’Brien JE. Type IV Total Anomalous Pulmonary Venous Connection. World J Pediatr Congenit Heart Surg 2017; 8:142-147. [DOI: 10.1177/2150135116682456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Mortality associated with correction of type IV total anomalous pulmonary venous connection (TAPVC) is generally reported in combination with other anatomic types. The objective of this study is to review surgical outcomes associated with the repair of type IV TAPVC by analyzing a multi-institutional cohort specific for this group. We also analyze patient-specific variables that may contribute to poor operative outcomes. Methods: A retrospective review of the Pediatric Cardiac Care Consortium (PCCC) registry identified patients who underwent repair of type IV TAPVC between 1982 and 2007. Variables reviewed included gender, prematurity, age at repair, anatomic pattern, presence of obstruction, associated anomalies, and operative mortality. Subclassifications were defined as type IV A (2+2 pattern), type IV B (3+1 pattern), and type IV C (bizarre). Results: Of the 2,248 patients with the diagnosis of TAPVC, 215 belonged to type IV. For type IV, the overall unadjusted mortality was 26%. There was no difference in mortality based on the particular anatomic drainage pattern. Twenty-eight percent had partial obstruction of the pulmonary venous return, with no patient having complete obstruction. Patients with obstruction had a significantly greater mortality than those without obstruction (39% vs 20%, P = .005). Approximately 16% of patients who present with obstruction of some pulmonary vein(s) underwent an emergency repair. Conclusion: Type IV TAPVC is a rare disease with a diverse anatomic presentation. Even though a small number of the patients with obstruction underwent emergent repair, mortality remained significant. This likely represents the intrinsic lung pathology that must be considered in the postoperative period.
Collapse
Affiliation(s)
- James D. St Louis
- Division of Cardiac Surgery, Department of Surgery, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Elizabeth M. Turk
- Division of Cardiac Surgery, Department of Surgery, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Jeffrey P. Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children’s Heart Institute, All Children’s Hospital, Saint Petersburg, Tampa, FL, USA
- Florida Hospital for Children, Orlando, FL, USA
| | - James E. O’Brien
- Division of Cardiac Surgery, Department of Surgery, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| |
Collapse
|
11
|
Yong MS, Yaftian N, Weintraub RG, Brizard CP, d'Udekem Y, Konstantinov IE. Outcomes of Surgery for Mixed Total Anomalous Pulmonary Venous Drainage in Children. Semin Thorac Cardiovasc Surg 2017; 29:338-344. [DOI: 10.1053/j.semtcvs.2017.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2017] [Indexed: 11/11/2022]
|
12
|
Furlanetto G, Furlanetto BHS, Henriques SRC, Lopes LM, Miranda ET, Porto CMG, Pereira MENT, Davini C, Espinosa EC. Mixed Type Total Anomalous Pulmonary Venous Connection. World J Pediatr Congenit Heart Surg 2014; 6:26-32. [DOI: 10.1177/2150135114554660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The mixed total anomalous pulmonary connection is a rare type of congenital cardiopathy. The occurrence of multiple connections of the pulmonary veins has important implication in the diagnosis and surgical planning. These types of total anomalous pulmonary venous connection (TAPVC) and the infracardiac have higher surgical mortality. Methods: Between December 1994 and July 2013, a total of 58 children underwent surgical treatment of TAPVC. Twenty-five (43.1%) patients had supracardiac connection, 15 (25.8%) patients had intracardiac type, 12 (20.6%) patients had a mixed type, and 6 (10.3%) patients had an infracardiac type. In children with mixed TAPVC, four (33.3%) patients had type I, five (41.6%) patients had type II, and three (25.0%) patients had type III. The diagnosis of TAPVC was performed in all patients using Doppler echocardiography, and they underwent cardiopulmonary bypass with aorta-bicaval cannulation and lately we use mild hypothermia with normal flow. The drainage channels were ligated in all patients. Results: The immediate surgical results were as follows: one (16.6%) death in the infracardiac group, four (16.0%) deaths in the supracardiac group, one (8.3%) death in the mixed group, and no death in the cardiac group (no statistical difference, P = .488). Conclusion: In this series of patients, the mixed TAPVC could be corrected only with preoperative two-dimensional Doppler echocardiography with good immediate results, and we believe that the use of computed angiotomography combined with three-dimensional reconstruction may improve the surgical outcome mainly in the mixed and infracardiac group of TAPVC.
Collapse
Affiliation(s)
| | - Beatriz H. S. Furlanetto
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | - Sandra R. C. Henriques
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | | | - Eduardo T. Miranda
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | - Carolina M. G. Porto
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | | | - Claudia Davini
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| | - Elssi C. Espinosa
- Instituto Furlanetto - Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil
| |
Collapse
|
13
|
Mishra A, Sharma P, Patel R, Panchal J, Solanki A. A rare variety of mixed total anomalous pulmonary venous connection. Asian Cardiovasc Thorac Ann 2014; 22:849-51. [PMID: 24887821 DOI: 10.1177/0218492313486120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a rare case of mixed supra- and infracardiac total anomalous pulmonary venous connection in a 2-month-old boy weighing 2.3 kg who was admitted with central cyanosis. Although the surgical repair was successful, the child died due to pulmonary hypertensive crisis.
Collapse
Affiliation(s)
- Amit Mishra
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, New Civil Hospital Campus, Asarwa, India.
| | - Pranav Sharma
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, New Civil Hospital Campus, Asarwa, India
| | - Ramesh Patel
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, New Civil Hospital Campus, Asarwa, India
| | - Jigar Panchal
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, New Civil Hospital Campus, Asarwa, India
| | - Atul Solanki
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, New Civil Hospital Campus, Asarwa, India
| |
Collapse
|
14
|
Chowdhury UK, Airan B, Malhotra A, Bisoi AK, Saxena A, Kothari SS, Kalaivani M, Venugopal P. Mixed total anomalous pulmonary venous connection: Anatomic variations, surgical approach, techniques, and results. J Thorac Cardiovasc Surg 2008; 135:106-16, 116.e1-5. [DOI: 10.1016/j.jtcvs.2007.08.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Revised: 08/23/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
|