Surgical treatment of a 56-year-old woman with an intracardiac type of total anomalous pulmonary venous connection

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

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

Late-onset total anomalous pulmonary venous connection in a 70-year-old woman

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac anomaly. There are a few reports of untreated TAPVC diagnosed in patients older than 60 years. Herein, we report the successful surgical treatment of TAPVC in a 70-year-old woman. A 70-year-old woman with TAPVC presented with symptoms of acute heart failure. We closed an atrial septal defect and performed tricuspid annuloplasty and commissurotomy of the pulmonary valve. Postoperative CT showed no residual shunt, and the pulmonary veins drained into the left atrium. She had an uneventful postoperative course. This report describes the case of the oldest known patient who underwent surgical treatment for TAPVC. Surviving into adulthood with little or no symptoms is uncommon in patients with TAPVC, and cases of late-onset TAPVC, such as our case, are rare. Nevertheless, close vigilance is necessary to prevent misdiagnosis in patients with this clinical presentation.

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

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

A case of mixed drainage total anomalous pulmonary venous return in an adult patient

Total anomalous pulmonary venous return is observed in 1.5 to 3% of congenital heart diseases. Urgent surgical intervention is required following the diagnosis, since severe heart failure is accompanied by cyanosis from the first days of life in most of the patients. This rare congenital heart disease is often managed in adulthood with surgery. Patients who survive until adulthood without a surgical intervention have a large atrial septal defect. A 36-year-old female patient was admitted with complaints of fatigability, shortness of breath, and cyanosis of the lips. Total anomalous pulmonary venous return, secundum-type atrial septal defect, ventricular septal defect, and pulmonary hypertension were diagnosed by transthoracic echocardiography and catheter angiography. After medical treatment, surgery was planned for the patient who responded to the pulmonary vasoreactivity test with iloprost.

Computed tomography features of supracardiac total anomalous pulmonary venous connection in an infant

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital anomaly of the pulmonary veins drainage. In this entity, the pulmonary veins, instead of draining to left atrium, connect abnormally to the systemic venous circulation. A right-to-left shunt is obligatory for survival. Based on its type and degree of pulmonary venous obstruction, TAPVC may result in pulmonary hypertension and congestive heart failure. In severe cases, urgent diagnosis and surgical correction is essential to reduce morbidity and mortality. Echocardiography as the first and safest imaging modality for cardiovascular abnormalities may fail in complete depiction of some complex feature of TAPVC. Computed tomography angiography is then a noninvasive and sensitive choice for mapping the pulmonary veins without the need for invasive cardiac catheterization. Contrast-enhanced MR angiography can be a radiation-free alternative. Authors present a computed tomography–detected supracardiac TAPVC with small patent ductus arteriosus in a 2 months cyanotic infant.

Total anomalous pulmonary venous connection in a 64-year-old man: a case report

We report a 64-year-old man with incidentally found uncorrected total anomalous pulmonary venous connection (TAPVC). There have been only a few case reports of untreated TAPVC diagnosed after 60 years of age. Also, this is a first case report of TAPVC in which ECG-gated CT and phase-contrast cine magnetic resonance imaging (PC-MRI) was performed. He was referred to our hospital for the surgery of rectal cancer. He had been diagnosed to have an arterial septal defect (ASD) and persistent left superior vena cava (PLSVC), and Eisenmenger's syndrome was thought to be the cause of cyanosis at first. The vertical vein in TAPVC was initially misdiagnosed as PLSVC on enhanced axial CT images reconstructed with 5-mm slice thickness with gapless. ECG-gated CT and PC-MRI were useful to confirm the diagnosis. The vertical vein in TAPVC is morphologically similar to PLSVC. This kind of abnormality would be somewhat difficult to diagnose on non-ECG-gated CT, and might be misdiagnosed as a large ASD and PLSVC.