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Li G, Meng B, Zhang C, Zhang W, Zhou X, Zhang Q, Ding Y. Total anomalous pulmonary venous connection in 80 patients: Primary sutureless repair and outcomes. Front Surg 2023; 9:1086596. [PMID: 36713670 PMCID: PMC9874290 DOI: 10.3389/fsurg.2022.1086596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Total anomalous pulmonary venous connection (TAPVC) is a rare but critical cardiac anomaly, in which pulmonary veins are connected to an abnormal location rather than the left atrium. The prognosis can be extremely poor without intervention, with a mortality of 80% during infancy. The purpose of this research is to summarize the outcomes and relevant risk factors of 80 total anomalous pulmonary venous connection (TAPVC) patients who underwent primary TAPVC sutureless repair and discuss the indications and benefits of primary sutureless repair. Methods This retrospective review included 80 patients with TAPVC who underwent primary sutureless repair at a single institution between January 2015 and December 2020. Patients were subdivided into 4 groups according to Darling's classification. Risk factors that increase the postoperative pulmonary vein flow velocity were explored by Multiple Linear regression. Results Anatomic TAPVC subtypes included supracardiac 35 (43.8%), cardiac 24 (30%), infracardiac 17 (21.2%), and mixed 4 (5%). Median age at repair was 16.5 days and median weight was 3.5 kg. Preoperative pulmonary venous obstruction (PVO)was presented in 20 (25%) patients. There were 2 early deaths and 1 late death. 2 patients developed postoperative PVO and none required reintervention. Prolonged cardiopulmonary bypass time (CPB) (p = 0.009), preoperative pneumonia (p = 0.022) and gender (p = 0.041) were found to be associated with the increase of postoperative pulmonary vein flow velocity. Discussion Under the primary sutureless technique, no statistical difference was observed among the 4 subgroups in terms of postoperative pulmonary vein flow velocity (p = 0.589). The primary sutureless technique may eliminate the differences between subtypes while decrease the postoperative PVO rate, which makes it applicable in any subtypes of TAPVC. Following the favorable outcomes in preventing postoperative PVO in all subtypes in this study, we advocate the indications for primary sutureless repair may expand further to all the TAPVC patients.
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Affiliation(s)
- Gefei Li
- Department of Pediatric Cardiothoracic Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Baoying Meng
- Department of Pediatric Cardiothoracic Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Cheng Zhang
- Department of Pediatric Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weimin Zhang
- Department of Pediatric Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiaodong Zhou
- Department of Pediatric Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Qing Zhang
- Department of Pediatric Cardiothoracic Surgery, Shenzhen Children's Hospital, Shenzhen, China,Correspondence: Qing Zhang Yiqun Ding
| | - Yiqun Ding
- Department of Pediatric Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China,Correspondence: Qing Zhang Yiqun Ding
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Paediatrician's guide to post-operative care for biventricular CHD: a review. Cardiol Young 2022; 32:1721-1727. [PMID: 36165406 DOI: 10.1017/s1047951122002955] [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
IMPORTANCE Paediatricians play an integral role in the lifelong care of children with CHD, many of whom will undergo cardiac surgery. There is a paucity of literature for the paediatrician regarding the post-operative care of such patients. OBSERVATIONS The aim of this manuscript is to summarise essential principles and pertinent lesion-specific context for the care of patients who have undergone surgery or intervention resulting in a biventricular circulation. CONCLUSIONS AND RELEVANCE Familiarity with common issues following cardiac surgery or intervention, as well as key details regarding specific lesions and surgeries, will aid the paediatrician in providing optimal care for these patients.
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3
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Wang G, Zhou G, Wang J, Wang H, Feng Z. Window anastomosis technique for repair of supracardiac total anomalous pulmonary venous connection in infants. J Card Surg 2022; 37:3988-3990. [PMID: 35989528 DOI: 10.1111/jocs.16871] [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: 07/20/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
Outcomes of operations for total anomalous pulmonary venous connection (TAPVC) have improved. However, postoperative pulmonary venous obstruction remains the most significant complication with high morbidity and mortality. We introduce a window anastomosis technique for repair of supracardiac TAPVC in infants. The mainstay of the surgical technique is to resect the anterior wall of the pulmonary vein confluence and part of the posterior wall of the left atrium to form a large and undistorted "window to window" anastomosis.
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Affiliation(s)
- Gang Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Gengxu Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Jieqiong Wang
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Hui Wang
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Zhichun Feng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Pediatrics, The Seventh Medical Center of the PLA General Hospital, Beijing, China
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Feins EN, Ireland C, Gauvreau K, Chávez M, Callahan R, Jenkins KJ, Baird CW. Pulmonary vein stenosis: Anatomic considerations, surgical management, and outcomes. J Thorac Cardiovasc Surg 2021; 163:2198-2207.e3. [PMID: 34801262 DOI: 10.1016/j.jtcvs.2021.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The study objective was to evaluate outcomes of pulmonary vein stenosis repair in a large single-center cohort. METHODS Clinical data from a pulmonary vein stenosis registry were retrospectively reviewed identifying patients who underwent pulmonary vein stenosis repair. The primary/index operation was defined as the patient's first pulmonary vein stenosis operation during the study period. RESULTS Between January 2007 and August 2019, 174 patients underwent pulmonary vein stenosis repair. Bilateral pulmonary vein stenosis occurred in 111 patients (64%); 71 patients (41%) had 4-vessel disease. Fifty-nine patients (34%) had primary pulmonary vein stenosis. Median age was 9 months (interquartile range, 5-27) and weight was 6.5 kg (4.7-10.2). Surgical techniques evolved and included ostial resection, unroofing, reimplantation, sutureless, modified sutureless, and a newer anatomically focused approach of pulmonary vein stenosis resection with lateralization or patch enlargement of the pulmonary vein-left atrium connection. Twenty-three patients (13%) required reoperation. Cumulative 2-year incidence of postoperative transcatheter intervention (balloon dilation ± stenting) was 64%. One-, 2-, and 5-year survivals were 71.2%, 66.8%, and 60.6%, respectively. There was no association between surgery type and reoperation rate (hazard ratio, 2.38, P = .25) or transcatheter intervention (hazard ratio, 0.97, P = .95). The anatomically focused repair was associated with decreased mortality on univariate (hazard ratio, 0.38, P = .042) and multivariable analyses (hazard ratio, 0.19, P = .014). Antiproliferative chemotherapy was also associated with decreased mortality (hazard ratio, 0.47, P = .026). CONCLUSIONS This large single-center surgical pulmonary vein stenosis experience demonstrates encouraging midterm results. A new anatomically focused repair strategy aims to alleviate pulmonary vein angulation to minimize turbulence and shows promising early outcomes. Continued follow-up is required to understand longer-term outcomes for this surgical approach.
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Affiliation(s)
- Eric N Feins
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
| | - Christina Ireland
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Mariana Chávez
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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5
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Feins EN, Callahan R, Baird CW. Pulmonary Vein Stenosis-Evolving Surgical Management of a Challenging Disease. CHILDREN (BASEL, SWITZERLAND) 2021; 8:631. [PMID: 34438522 PMCID: PMC8392559 DOI: 10.3390/children8080631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/27/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
Pulmonary vein stenosis (PVS) is an extremely challenging clinical problem in congenital heart disease. It has traditionally required multimodal therapy given its complex underlying pathophysiology. As with other modalities, surgical therapy has undergone tremendous evolution since the 1950s. These evolving strategies have been based upon an improved understanding of the substrates that cause PVS and recurrent vein obstruction. More recent anatomic-based surgical strategies have focused on the pulmonary vein course, and how adjacent mediastinal structures can create a fulcrum effect on the pulmonary veins as they pass from the lung parenchyma to the left atrium. The consequent angulation of pulmonary veins creates altered wall shear stress and likely serves as a nidus for recurrent PVS. Encouraging early results suggest that eliminating pulmonary vein angulation and shortening/straightening the pulmonary vein course may prove effective in surgically managing PVS.
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Affiliation(s)
- Eric N. Feins
- Department of Cardiac Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
| | - Ryan Callahan
- Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
| | - Christopher W. Baird
- Department of Cardiac Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
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Frank DB, Levy PT, Stiver CA, Boe BA, Baird CW, Callahan RM, Smith CV, Vanderlaan RD, Backes CH. Primary pulmonary vein stenosis during infancy: state of the art review. J Perinatol 2021; 41:1528-1539. [PMID: 33674714 DOI: 10.1038/s41372-021-01008-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/13/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
Primary pulmonary vein stenosis (PPVS) is an emerging problem among infants. In contrast to acquired disease, PPVS is the development of stenosis in the absence of preceding intervention. While optimal care approaches remain poorly characterized, over the past decade, understanding of potential pathophysiological mechanisms and development of novel therapeutic strategies are increasing. A multidisciplinary team of health care providers was assembled to review the available evidence and provide a common framework for the diagnosis, management, and treatment of PPVS during infancy. To address knowledge gaps, institutional and multi-institutional approaches must be employed to generate knowledge specific to ex-premature infants with PPVS. Within individual institutions, creation of a team comprised of dedicated health care providers from diverse backgrounds is critical to accelerate clinical learning and provide care for infants with PPVS. Multi-institutional collaborations, such as the PVS Network, provide the infrastructure and statistical power to advance knowledge for this rare disease.
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Affiliation(s)
- David B Frank
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Corey A Stiver
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Brian A Boe
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Christopher W Baird
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Ryan M Callahan
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Rachel D Vanderlaan
- Department of Thoracic Surgery, New York Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Carl H Backes
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
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7
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Management outcomes of primary pulmonary vein stenosis. J Thorac Cardiovasc Surg 2020; 159:1029-1036.e1. [DOI: 10.1016/j.jtcvs.2019.08.105] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 01/07/2023]
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8
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Choi EY, Lee CH, Park SJ, Jang SI, Kim ES. Assessing the recently noted surgical outcome of isolated total anomalous pulmonary venous connection repair: A single-secondary center experience. J Card Surg 2019; 34:1526-1532. [PMID: 31614026 DOI: 10.1111/jocs.14284] [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: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Total anomalous pulmonary venous connection (TAPVC) is a rare cyanotic congenital heart defect. This study aimed to evaluate the outcome of isolated TAPVC repairs and the prognoses of affected patients in the last 12 years at a single center. METHODS We retrospectively analyzed the medical records of 51 patients who underwent isolated TAPVC repair from 2007 to 2018. RESULTS The median age at operation was 19 days, and the median body weight was 3.3 kg. Thirteen (25.5%) patients had emergency operations, and the median follow-up period was 29.54 ± 36.77 months. Early mortality was noted in five patients and late mortality was noted in one patient. Pulmonary vein stenosis was observed in 22 patients within 3 to 6 months after the operation, and six patients required reoperation or transcatheter interventions. Low birth weight, small left atrial volume, long operation time, and preoperative heart failure were identified as risk factors for mortality. CONCLUSIONS Isolated TAPVC can rapidly lead to hemodynamic instability during the neonatal period and is associated with high mortality rates. Increasing the prenatal diagnosis rate and stabilizing the patients' condition before the operation are considered important for improving the surgical outcome.
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Affiliation(s)
- Eun-Young Choi
- Department of Pediatrics, Sejong Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea.,Department of Pediatrics, College of Medicine, Kangwon National University, Gangwon-do, Republic of Korea
| | - Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
| | - Su-Jin Park
- Department of Pediatrics, Sejong Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
| | - So-Ick Jang
- Department of Pediatrics, Sejong Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
| | - Eun Sun Kim
- Department of Pediatrics, College of Medicine, Kangwon National University, Gangwon-do, Republic of Korea
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DiLorenzo MP, Santo A, Rome JJ, Zhang H, Faerber JA, Mercer-Rosa L, Hopper RK. Pulmonary Vein Stenosis: Outcomes in Children With Congenital Heart Disease and Prematurity. Semin Thorac Cardiovasc Surg 2018; 31:266-273. [PMID: 30278272 DOI: 10.1053/j.semtcvs.2018.09.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 09/26/2018] [Indexed: 11/11/2022]
Abstract
Pulmonary vein stenosis (PVS) is a rare condition that has been linked to prematurity and congenital heart disease (CHD). Despite these associations, treatment options are limited and outcomes are guarded. We investigated differences in PVS outcomes based on the presence of CHD and prematurity, and risk factors for mortality or lung transplantation in PVS. Single-center retrospective cohort study of patients diagnosed with PVS between January 2005 and May 2016 and identified by ICD codes with chart validation. Cox proportional hazard models assessed risk factors for the composite outcome of mortality or lung transplantation. Ninety-three patients with PVS were identified: 65 (70%) had significant CHD, 32 (34%) were premature, and 14 (15%) were premature with CHD. Sixty-five (70%) underwent a PVS intervention and 42 (46%) underwent ≥2 interventions. Twenty-five subjects (27%) died or underwent lung transplant 5.8 months (interquartile range [IQR] 1.1, 15.3) after diagnosis. There was no difference in age at diagnosis or mortality based on presence of CHD or prematurity. PVS diagnosis before age 6 months and greater than 1 pulmonary vein affected at diagnosis were associated with higher mortality (hazards ratio [HR] 3.4 (95% confidence interval 1.5, 7.5), P = 0.003, and HR 2.1 per additional vein affected (95% confidence interval 1.3, 3.4), P = 0.004, respectively). Survival in children with PVS is poor, independent of underlying CHD or prematurity. Younger age and greater number of veins affected at diagnosis are risk factors for worse outcome. Understanding causal mechanisms and development of treatment strategies are necessary to improve outcomes.
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Affiliation(s)
- Michael P DiLorenzo
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York.
| | - Ashley Santo
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan J Rome
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Huayan Zhang
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer A Faerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura Mercer-Rosa
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel K Hopper
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Kalfa D, Belli E, Bacha E, Lambert V, di Carlo D, Kostolny M, Nosal M, Horer J, Salminen J, Rubay J, Yemets I, Hazekamp M, Maruszewski B, Sarris G, Berggren H, Ebels T, Baser O, Lacour-Gayet F. Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. J Thorac Cardiovasc Surg 2018; 156:278-286. [DOI: 10.1016/j.jtcvs.2018.02.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 02/07/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
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11
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Backes CH, Nealon E, Armstrong AK, Cua CL, Mitchell C, Krishnan U, Vanderlaan RD, Song MK, Viola N, Smith CV, McConnell PI, Rivera BK, Bridge J. Pulmonary Vein Stenosis in Infants: A Systematic Review, Meta-Analysis, and Meta-Regression. J Pediatr 2018; 198:36-45.e3. [PMID: 29650415 DOI: 10.1016/j.jpeds.2018.02.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/08/2018] [Accepted: 02/13/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To quantify outcomes of infants (<1 year of age) diagnosed with pulmonary vein stenosis (PVS). STUDY DESIGN MEDLINE (PubMed), Scopus, and Web of Science were searched through February 1, 2017, with no language restrictions. Publications including infants diagnosed with primary PVS, defined as the absence of preceding intervention(s), were considered. The study was performed according to Meta-analysis of Observational Studies in Epidemiology guidelines, the Systematic Reviews, and Meta-Analysis checklist, and registered prospectively. The quality of selected reports was critically examined. Data extraction was independently performed by multiple observers with outcomes agreed upon a priori. Data were pooled using an inverse variance heterogeneity model with incidence of mortality the primary outcome of interest. RESULTS Forty-eight studies of 185 infants were included. Studies were highly diverse with regards to the participants, interventions, and outcomes reported. The median (range) age at diagnosis was 5.0 (0.1-11.6) months. Pooled mortality was 58.5% (95% CI 49.8%-67.0%, I2 = 21.4%). We observed greater mortality incidence among infants with 3 or 4 vein stenoses than in those with 1 or 2 vein stenoses (83.3% vs 36.1%; P < .01). We observed greater mortality among infants with bilateral than unilateral disease (78.7% vs 26.0%; P < .01). CONCLUSIONS Studies of primary PVS during infancy are highly variable in their methodological quality and estimates of clinical outcomes; therefore, estimates of prognosis remain uncertain. Multicenter, interdisciplinary collaborations, including alignment of key outcome measurements, are needed to answer questions beyond the scope of available data.
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Affiliation(s)
- Carl H Backes
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH; Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
| | - Erin Nealon
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Aimee K Armstrong
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Clifford L Cua
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Courtney Mitchell
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Usha Krishnan
- Department of Pediatric Cardiology, Columbia University, New York, NY
| | - Rachel D Vanderlaan
- Division of Cardiac Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Nicola Viola
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Southampton, Southampton, United Kingdom; Department of Cardiothoracic Surgery, Children's Hospital of Southampton, Southampton, United Kingdom
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA
| | - Patrick I McConnell
- Department of Surgery, The Ohio State University, College of Medicine, Columbus, OH; Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, OH; Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Brian K Rivera
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Jeffrey Bridge
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, OH
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12
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Tremblay C, Yoo SJ, Mertens L, Seed M, Jacques F, Slorach C, Vanderlaan R, Greenway S, Caldarone C, Coles J, Grosse-Wortmann L. Sutureless Versus Conventional Pulmonary Vein Repair: A Magnetic Resonance Pilot Study. Ann Thorac Surg 2018; 105:1248-1254. [PMID: 29482852 DOI: 10.1016/j.athoracsur.2017.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two different surgical techniques are used to repair anomalous pulmonary venous connection or pulmonary vein (PV) stenosis: the classic repair (CR) and the sutureless repair (SR). The purpose of this study was to compare the prevalence of PV stenosis between the two surgical approaches. METHODS Patients were prospectively recruited irrespective of symptoms or previous imaging findings. Cardiac magnetic resonance imaging and echocardiography were performed in a blinded fashion on the same day. RESULTS Twenty-five patients (13 male) after PV repair completed the study. Twelve patients had undergone CR and 13 SR (in 1 patient as a reoperation after CR). The median age at operation was 2 months (range: 1 day to 5 years) and was similar for both groups; the median age at the time of cardiac magnetic resonance was 9 years (range: 6 to 17 years) and 9 years (range: 6 to 14 years) for the CR and SR, respectively. Four patients had PV stenosis. All 4 patients had had total anomalous pulmonary venous connection, 1 patient had undergone repair with the CR and 2 with a primary SR; 1 patient had first undergone a CR, followed by a SR for stenosis. Echocardiography provided complete visualization of all PVs in only 11 patients (44%). Notable stenosis of at least one PV was missed by echocardiography in 2 patients. CONCLUSIONS This pilot study indicates that not only CR but also SR may be burdened by a risk of postoperative PV stenosis. Magnetic resonance imaging should be used routinely for the postoperative monitoring for the development of PV obstruction.
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Affiliation(s)
- Cornelia Tremblay
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mike Seed
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Frederic Jacques
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cameron Slorach
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Vanderlaan
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Steven Greenway
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Caldarone
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - John Coles
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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13
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St Louis JD, McCracken CE, Turk EM, Hancock HS, Menk JS, Harvey BA, Vinocur JM, Oster ME, Moller JH, Spector LG, Kochilas LK. Long-Term Transplant-Free Survival After Repair of Total Anomalous Pulmonary Venous Connection. Ann Thorac Surg 2017; 105:186-192. [PMID: 28847536 DOI: 10.1016/j.athoracsur.2017.05.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/01/2017] [Accepted: 05/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Long-term survival, risk of transplantation, and causes of death after repair of total anomalous pulmonary venous connection (TAPVC) remain unknown. By linking the Pediatric Cardiac Care Consortium with the National Death Index and the United Network for Organ Sharing, we evaluated long-term transplant-free survival in children undergoing repair of TAPVC. METHODS We identified 777 infants within the Pediatric Cardiac Care Consortium who underwent TAPVC repair (median 21 days; interquartile range, 5 to 80) and had sufficient personal identifiers for linkage with the National Death Index and United Network for Organ Sharing. Sixty-six deaths, ten cardiac transplantations, and one bilateral lung transplantation had occurred by the end of 2014. Data collected included age and weight at time of procedure, TAPVC type, associated cardiac lesions, and postoperative length of stay. The study cohort was divided into simple and complex TAPVC based on the presence of an associated cardiac lesion. Parametric survival plots were constructed, and risk factor analyses were performed to identify demographic and clinical characteristics associated with long-term outcomes. RESULTS Mortality or need for transplantation was 9.7% with a median follow-up of 18.4 years and a median age of death or transplant of 0.74 years. The risk of mortality and transplant after TAPVC repair was highest during the first 18 months after hospital discharge. Cardiac causes accounted for the majority of deaths. Multivariate regression models for transplant-free survival demonstrated that complex TAPVC, mixed TAPVC, and postoperative length of stay were associated with increased risk of death/transplant. CONCLUSIONS Transplant-free survival after TAPVC repair is excellent, with most deaths or transplant events occurring early. Factors associated with the worst long-term outcomes included complex TAPVC, mixed TAPVC, and prolonged postoperative length of stay.
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Affiliation(s)
- James D St Louis
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Courtney E McCracken
- Department of Pediatrics, Emory University School of Medicine and Children's Health Care of Atlanta, Atlanta, Georgia
| | - Elizabeth M Turk
- Children's Mercy Hospital, Division of Cardiovascular Surgery, Kansas City, Missouri
| | - Hayley S Hancock
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Jeremiah S Menk
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota
| | - Brian A Harvey
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Jeffrey M Vinocur
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Matthew E Oster
- Department of Pediatrics, Emory University School of Medicine and Children's Health Care of Atlanta, Atlanta, Georgia
| | - James H Moller
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Logan G Spector
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Lazaros K Kochilas
- Department of Pediatrics, Emory University School of Medicine and Children's Health Care of Atlanta, Atlanta, Georgia
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14
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Cory MJ, Ooi YK, Kelleman MS, Vincent RN, Kim DW, Petit CJ. Reintervention Is Associated With Improved Survival in Pediatric Patients With Pulmonary Vein Stenosis. JACC Cardiovasc Interv 2017; 10:1788-1798. [PMID: 28823777 DOI: 10.1016/j.jcin.2017.05.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate survival following catheter intervention in pediatric patients with pulmonary vein stenosis (PVS). BACKGROUND Despite aggressive surgical and catheter intervention on PVS in children, recurrence and progression of stenosis can lead to right heart failure and death. Clinicians continue to seek effective treatment options for PVS. METHODS A single-center, retrospective study was performed including all patients <18 years of age who underwent catheter intervention (balloon angioplasty and bare-metal stent and drug-eluting stent insertion) on PVS. Endpoints included death, vein loss, and rate of reintervention. RESULTS Thirty patients underwent intervention (balloon angioplasty, n = 9; bare-metal stent, n = 5; drug-eluting stent, n = 16) at a median age of 6.4 months (4.3 to 9.9 months). Median follow-up duration was 30.6 months (77 days to 10.5 years). Fourteen patients (47%) died at a median of 2.0 months (0.4 to 3.2 months) following intervention. There was no association between DES placement and survival (p = 0.067). Reintervention (catheter or surgical) was associated with improved survival (p = 0.001), with a 1-year survival rate of 84% compared with 25% for no reintervention. Vein loss occurred in 34 of 58 (59%) veins at a median of 3.3 months (1.0 to 5.0 months). One-year vein survival was higher with DES implantation (p = 0.031) and with reintervention (p < 0.001). CONCLUSIONS DES implantation at first catheter intervention appears to be associated with improved vein survival but may not result in improved patient survival. However, reintervention appears to be associated with improved patient survival and vein patency, suggesting that despite mode of treatment, frequent surveillance is important in the care of these patients.
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Affiliation(s)
- Melinda J Cory
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia
| | - Yinn K Ooi
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia
| | - Michael S Kelleman
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia
| | - Robert N Vincent
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia
| | - Dennis W Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher J Petit
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia.
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15
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Yoshimura N, Fukahara K, Yamashita A, Doi T, Takeuchi K, Yamashita S, Homma T, Yokoyama S, Aoki M, Ikeno Y. Surgery for total anomalous pulmonary venous connection: primary sutureless repair vs. conventional repair. Gen Thorac Cardiovasc Surg 2017; 65:245-251. [DOI: 10.1007/s11748-017-0769-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/05/2017] [Indexed: 11/30/2022]
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16
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Surgical approaches to pulmonary vein stenosis in pediatric heart transplant recipients: Opportunity for success in a difficult situation. J Heart Lung Transplant 2016; 35:1135-7. [DOI: 10.1016/j.healun.2016.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 06/15/2016] [Accepted: 06/22/2016] [Indexed: 11/18/2022] Open
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17
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Zhu J, Ide H, Fu YY, Teichert AM, Kato H, Weisel RD, Maynes JT, Coles JG, Caldarone CA. Losartan ameliorates “upstream” pulmonary vein vasculopathy in a piglet model of pulmonary vein stenosis. J Thorac Cardiovasc Surg 2014; 148:2550-7. [DOI: 10.1016/j.jtcvs.2014.07.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/26/2014] [Accepted: 07/16/2014] [Indexed: 12/29/2022]
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18
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Surgical Repair of Pulmonary Venous Stenosis: A Word of Caution. Ann Thorac Surg 2014; 98:1687-91; discussion 1691-2. [DOI: 10.1016/j.athoracsur.2014.05.082] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/30/2014] [Accepted: 05/27/2014] [Indexed: 11/15/2022]
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19
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Kumar N, Aksoy I, Pison L, Timmermans C, Maessen J, Crijns H. Management Of Pulmonary Vein Stenosis Following Catheter Ablation Of Atrial Fibrillation. J Atr Fibrillation 2014; 7:1060. [PMID: 27957081 DOI: 10.4022/jafib.1060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/14/2014] [Accepted: 06/11/2014] [Indexed: 01/31/2023]
Abstract
There is limited literature available regarding PV (pulmonary vein) stenosis management. Starting from its incidence, subsequent follow up using imaging technologies to monitor the success and the way of managing different groups pose varied opinions. However, with newer technological advancements and better understanding of mechanism of the atrial fibrillation ablation, the incidence of PV stenosis secondary to catheter ablation is declining. This paper highlights the current trends and future of management of PV stenosis secondary to catheter ablation for atrial fibrillation.
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Affiliation(s)
| | | | | | | | - Jos Maessen
- Department of cardiac surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht,the Netherlands
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20
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Yoshimura N, Fukahara K, Yamashita A, Doki Y, Takeuchi K, Higuma T, Senda K, Toge M, Matsuo T, Nagura S, Aoki M, Sakata K, Obi H. Current topics in surgery for isolated total anomalous pulmonary venous connection. Surg Today 2014; 44:2221-6. [DOI: 10.1007/s00595-014-0877-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
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21
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Yoshimura N, Fukahara K, Yamashita A, Doki Y, Doi T, Takeuchi K, Higuma T, Senda K, Toge M, Nagura S. Management of pulmonary venous obstruction. Gen Thorac Cardiovasc Surg 2012; 60:785-91. [DOI: 10.1007/s11748-012-0154-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Indexed: 11/28/2022]
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22
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Ou-Yang WB, Zhang H, Yang KM, Li SJ. Modified anastomosis for repair of supracardiac total anomalous pulmonary venous connection in infants. J Card Surg 2012; 27:387-9. [PMID: 22519526 DOI: 10.1111/j.1540-8191.2012.01448.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Recurrent pulmonary venous obstruction after repair of total anomalous pulmonary venous connection (TAPVC) is usually restricted to the anastomosis between the pulmonary venous confluence and the left atrium. We describe a modified technique for repair of supracardiac TAPVC in infants. An L-shaped incision of left atrium is utilized and the right-sided anastomosis is enlarged by using autologous pericardium to create a large and tension-free anastomosis.
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Affiliation(s)
- Wen-Bin Ou-Yang
- Institute of Cardiovascular Diseases Research, Department of Pediatric Cardiac Surgery, Second Xiangya Hospital, Central South University, Changsha, P.R. China
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23
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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.
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Affiliation(s)
- Ali Riza Karaci
- Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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24
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Balasubramanian S, Rehman M, Gauvreau K, Jenkins KJ. Bilateral Disease and Early Age at Presentation Are Associated with Shorter Survival in Patients with Congenital Heart Disease and Intraluminal Pulmonary Vein Stenosis. CONGENIT HEART DIS 2012; 7:378-86. [DOI: 10.1111/j.1747-0803.2012.00647.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Balasubramanian S, Marshall AC, Gauvreau K, Peng LF, Nugent AW, Lock JE, McElhinney DB. Outcomes After Stent Implantation for the Treatment of Congenital and Postoperative Pulmonary Vein Stenosis in Children. Circ Cardiovasc Interv 2012; 5:109-17. [DOI: 10.1161/circinterventions.111.964189] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sowmya Balasubramanian
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Audrey C. Marshall
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Kimberlee Gauvreau
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Lynn F. Peng
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Alan W. Nugent
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - James E. Lock
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Doff B. McElhinney
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
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26
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Hickey EJ, Caldarone CA. Surgical management of post-repair pulmonary vein stenosis. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2011; 14:101-108. [PMID: 21444056 DOI: 10.1053/j.pcsu.2011.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Obstructed pulmonary venous drainage - either in association with total anomalous pulmonary venous drainage, congenital stenosis, or post-repair stenosis - is associated with poor outcome. Post-repair stenosis typically involves fibrotic scar tissue extending from the site of anastomosis. "Sutureless" repair techniques avoid direct left atrial-pulmonary vein suture lines by instead reconstituting atrial tissue to posterior pericardium. Hence, the repair leaves widely decompressed pulmonary veins in the posterior mediastinum draining directly into the left atrium as a 'controlled bleed.' In our experience, late outcomes are significantly more favorable with sutureless repair techniques versus conventional pulmonary vein surgery. Therefore, after these encouraging results, we have now extended the application of this repair strategy to all scenarios of pulmonary vein surgery, including primary repair of unobstructed total anomalous pulmonary venous connection. The sutureless repair is versatile and facile. In particular, complex geometry of multiple decompressed veins can be easily accommodated by wide left atrial-pericardial suture lines. Common pitfalls can be avoided by mobilizing and protecting the phrenic pedicle and preserving the integrity of the areolar connective tissue and pleuro-parietal membrane. Overall, sutureless repair of anomalous or stenotic pulmonary veins appears safe and effective. Furthermore, in patients known to be at high risk of recurrent stenosis, sutureless techniques appear to offer improved freedom from recurrent stenosis.
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Affiliation(s)
- Edward J Hickey
- Division of Cardiovascular Surgery and Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Canada
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27
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Booher AM, Bach DS. Acquired pulmonary vein stenosis: one problem, two mechanisms. J Am Soc Echocardiogr 2010; 23:904.e1-3. [PMID: 20138470 DOI: 10.1016/j.echo.2009.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Indexed: 12/15/2022]
Abstract
Until the last decade, acquired pulmonary vein (PV) stenosis in the adult population was a rare finding, caused by neoplasm or inflammatory conditions such as sarcoidosis or fibrosing mediastinitis. With the increased use of catheter-based ablation for the treatment of atrial fibrillation, PV stenosis is increasingly recognized as a complication of this procedure. Additionally, PV stenosis has been described as a rare complication of cardiac surgery. This report describes two cases of PV stenosis, one acquired as a result of multiple left atrial ablation procedures and the other after surgical cannulation of the right upper PV.
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Affiliation(s)
- Anna M Booher
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109-5853, USA.
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28
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Jang SI, Song JY, Kim SJ, Choi EY, Shim WS, Lee C, Lim HG, Lee CH. The recent surgical result of total anomalous pulmonary venous return. Korean Circ J 2010; 40:31-5. [PMID: 20111650 PMCID: PMC2812795 DOI: 10.4070/kcj.2010.40.1.31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 07/27/2009] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent surgical results from total anomalous pulmonary venous return (TAPVR) are reported to have improved; however, mortality and morbidity are still high in the univentricles. This review was performed in order to demonstrate surgical results from TAPVR for recent years in a single institute. SUBJECTS AND METHODS A total of 53 patients with TAPVR underwent surgery between January 2000 and December 2008. Preoperative anatomy and hemodynamics were evaluated by 2-dimensional echocardiogram. We reviewed medical records on preoperative management, age, and body weight at time of surgery, postoperative mortality, and pulmonary venous obstruction. RESULTS The study included 36 biventricle patients and 17 univentricle patients. Median age and weight at time of surgery were 26 days and 3.5 kg, respectively. During the mean follow up period of 48.2 months, a total of 11 deaths and 8 early deaths occurred. Postoperative pulmonary venous stenosis occurred in 8 patients. Among 36 biventricle patients, mortality occurred in 1 patient and postoperative pulmonary venous stenosis occurred in 6 patients. No statistical significances were observed between postoperative pulmonary venous stenosis and other factors. Among 17 univentricule patients, mortality was 10, including 7 early deaths, and postoperative pulmonary venous stenosis occurred in 2 patients. Combined palliations were modified Blalock-Taussig (BT) shunts in 7, pulmonary artery banding (PAB) in 3, bidirectional cavopulmonary shunt in 5, and the Fontan procedure in 1. The highest mortality was recorded in patients with a modified BT shunt (85.7%) and next in patients with PAB (66.6%). Mortality was not related to anatomy of TAPVR, nor preoperative obstruction, but with significant age and weight at time of surgery. CONCLUSION Despite improvement in operative results from TAPVR, surgery in univentricles is highly risky, especially with low weight and early age, with concomitant palliation.
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Affiliation(s)
- So-Ick Jang
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
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29
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Complete Pulmonary Venous Occlusion After Radiofrequency Ablation. Ann Thorac Surg 2010; 89:340; author reply 340. [DOI: 10.1016/j.athoracsur.2009.06.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 04/28/2009] [Accepted: 06/18/2009] [Indexed: 11/16/2022]
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30
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Chu MA, Choi BH, Choi HJ, Kim YH, Kim GJ, Cho JY, Hyun MC, Lee SB. Clinical features and results of recent total anomalous pulmonary venous connection : Experience in a university hospital (Clinical study of total anomalous pulmonary venous connection). KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.2.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mi Ae Chu
- Department of Pediatrics, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Byung Ho Choi
- Department of Pediatrics, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Hee Joung Choi
- Department of Pediatrics, Pochon CHA University, Gumi, Korea
| | - Yeo Hyang Kim
- Department of Pediatrics, College of Medicine, Keimyung University, Daegu, Korea
| | - Gun Jik Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Joon Yong Cho
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Chul Hyun
- Department of Pediatrics, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Bum Lee
- Department of Pediatrics, College of Medicine, Kyungpook National University, Daegu, Korea
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31
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Hirsch JC, Bove EL. Total anomalous pulmonary venous connection. Multimed Man Cardiothorac Surg 2007; 2007:mmcts.2006.002253. [PMID: 24414203 DOI: 10.1510/mmcts.2006.002253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is subdivided into four types: supracardiac, cardiac, infracardiac, and mixed. The principle of operative repair is to establish an unobstructed communication between the pulmonary veins and the left atrium, interrupt the connections with the systemic venous circulation, and remove intracardiac shunting. The specific repair is dependent on the type of anomalous connection. Pulmonary venous obstruction is a significant and complex complication following TAPVC repair. The introduction of the sutureless pericardial marsupialization technique has greatly improved the outcome in this difficult patient group.
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Affiliation(s)
- Jennifer C Hirsch
- Section of Cardiac Surgery, Division of Pediatric Cardiovascular Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA
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32
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Lacour-Gayet F. Surgery for pulmonary venous obstruction after repair of total anomalous pulmonary venous return. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006:45-50. [PMID: 16638547 DOI: 10.1053/j.pcsu.2006.02.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The major complication and the main cause of reoperation following surgery for total anomalous pulmonary venous return (TAPVR) is the occurrence of pulmonary venous obstruction. Outcomes after surgical repair of TAPVR have greatly improved in the last 10 years; however, the complex forms of TAPVR, particularly when associated with single ventricle and heterotaxy, still carry a high risk of failure. The pathology of pulmonary venous obstruction following TAPVR surgery is a fibrous intimal hyperplasia associated with some medial hypertrophy. There is an increasing severity in the spectrum of lesions from anastomotic stricture to pulmonary vein ostial stenosis and diffuse pulmonary vein stenosis. For anastomotic lesions, revision of the TAPVR anastomosis by patch enlargement of the left atrial anastomosis provides good results. On the contrary, conventional techniques in cases of pulmonary vein ostial stenosis had very poor results. The sutureless repair technique introduced in 1996 provides better midterm results than any other technique, with freedom from mortality and recurrence improving from 65% to 90%. The sutureless technique is described in detail, with emphasis on the need for resection of the pulmonary vein scar tissue and on the different techniques needed respectively on the right and the left side. In our experience, using an atraumatic technique at the initial repair has greatly decreased the occurrence of late pulmonary venous obstruction.
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