1
|
Celona A, Caruso E, Farruggio S, Oreto L, Inserra MC, Cannizzaro MT, D'Angelo T, Mazziotti S, Ortiz DA, Calvaruso D, Booz C, Agati S, Di Mambro C, Privitera G, Fiumanò G, Romeo P. Anomalous venoatrial connections - CT and MRI assessment. Heliyon 2023; 9:e18462. [PMID: 37576327 PMCID: PMC10415622 DOI: 10.1016/j.heliyon.2023.e18462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Abnormal venous atrial (VA) connections present a congenital heart disease (CHD) challenge for pediatric cardiologists. Fully anatomical evaluation is very difficult in prenatal and perinatal follow-up, but it has a profound impact on surgical correction and outcome. The echocardiogram is first-line imaging and represents the gold standard tool for simple abnormal VA connection. CT and MRI are mandatory for more complex heart disease and "nightmare cases". 3D post-processing of volumetric CT and MRI acquisition helps to clarify anatomical relationships and allows for the creation of 3D printing models that can become crucial in customizing surgical strategy. Our article describes a ten-year (2013-2022) tertiary referral CHD center of abnormal AV connections investigated with CT and MRI, illustrating most of these complex diseases with the help of volume rendering (VR) or multiplanar reconstructions (MPR). The nightmarish cases will also be addressed due to the complex cardiovascular arrangement that requires a challenging surgical solution for correction along with the post-surgical complications.
Collapse
Affiliation(s)
- Antonio Celona
- UOC Radiodiagnostica, San Vincenzo Hospital, Provincial Health Agency of Messina, Taormina, Italy
| | - Elio Caruso
- Centro Cardiologico Pediatrico del Mediterraneo (CCPM), San Vincenzo Hospital, Provincial Health Agency of Messina, Taormina, Italy
| | - Silvia Farruggio
- Centro Cardiologico Pediatrico del Mediterraneo (CCPM), San Vincenzo Hospital, Provincial Health Agency of Messina, Taormina, Italy
| | - Lilia Oreto
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Italy
| | | | | | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Policlinico “G. Martino”, Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Silvio Mazziotti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, Messina, Italy
| | - David Angel Ortiz
- Centro Cardiologico Pediatrico del Mediterraneo (CCPM), San Vincenzo Hospital, Provincial Health Agency of Messina, Taormina, Italy
| | | | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | | | | | | | - Giuseppa Fiumanò
- UOC Radiologia San Marco, AOU Policlinico “G. Rodolico” San Marco, Catania, Italy
| | - Placido Romeo
- UOC Radiologia San Marco, AOU Policlinico “G. Rodolico” San Marco, Catania, Italy
| |
Collapse
|
2
|
Kamata M, Tsujita M. Pulmonary vein compression by transesophageal echocardiography probe demonstrated using epicardial echocardiography. Paediatr Anaesth 2023; 33:668-669. [PMID: 37401901 DOI: 10.1111/pan.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/02/2023] [Accepted: 04/16/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Mineto Kamata
- Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Miki Tsujita
- Department of Anesthesiology, Saitama Medical University International Medical Center, Saitama, Japan
| |
Collapse
|
3
|
Gui L, Wang AB, Zi J, Ai GY, Wang HH, Zhu M, Liang H. The Clinical Characteristics of 88 Patients with Total Anomalous Pulmonary Venous Connection and Risk Factors Associated with Early Postoperative Death. Int J Gen Med 2022; 15:7809-7816. [PMID: 36267425 PMCID: PMC9576494 DOI: 10.2147/ijgm.s380677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the outcomes and risk factors of early postoperative death (within 30 days after surgery) in a single-center after repair of total anomalous pulmonary venous connection (TAPVC). METHODS The clinical data of 88 children who had been diagnosed with TAPVC and underwent radical operation in the Shandong Provincial Hospital Affiliated with Shandong First Medical University (China) from January 2015 to July 2021 were retrospectively analyzed. All the patients were divided into the survival group (n = 81) and the death group (n = 7) for the analysis of preoperative and postoperative clinical data. The variables associated with early postoperative death were statistically analyzed to obtain the risk factors for early postoperative death of TAPVC. RESULTS Of the 88 patients included in this study, 7 (7.95%) patients died early, including 4 supracardiac and 3 infracardiac cases. Recurrent pulmonary vein obstruction occurred in 2 patients after discharged from hospital, and both were intracardiac TAPVC. Delayed death occurred in 2 children, both of which were intracardiac TAPVC cases. According to univariate analysis, the risk factors statistically significantly associated with the early postoperative death included infracardiac type (P = 0.08), preoperative maximum pulmonary vein flow velocity (P = 0.031), preoperative mechanical ventilation (P = 0.043), preoperative maximum pulmonary artery pressure (P = 0.000), intraoperative cardiopulmonary bypass time (P = 0.003) and intraoperative aortic cross-clamp time (P = 0.000). CONCLUSION Infracardiac type of TAPVC, preoperative maximum pulmonary vein flow velocity, preoperative mechanical ventilation, preoperative maximum pulmonary artery pressure, intraoperative cardiopulmonary bypass time and aortic cross-clamp time are the risk factors for early postoperative death.
Collapse
Affiliation(s)
- Lin Gui
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - An-Biao Wang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Jie Zi
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Ge-Yi Ai
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Hui-Hui Wang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Mei Zhu
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Correspondence: Mei Zhu; Hao Liang, Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jing Wu Road, Huai Yin District, Jinan, 250021, People’s Republic of China, Tel +86-15653101616; +86-13506411901, Email ;
| | - Hao Liang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| |
Collapse
|
4
|
Transcatheter closure of patent vertical vein after repair of total anomalous pulmonary venous connection: a case series. Cardiol Young 2021; 31:1853-1857. [PMID: 33977891 DOI: 10.1017/s1047951121001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Total anomalous pulmonary venous connection is a rare cyanotic CHD that requires surgical repair. An unligated vertical vein after total anomalous pulmonary venous connection surgery may help to decrease the episodes of post-operative pulmonary hypertensive crises, low cardiac output syndrome, and mortality. The aim was to assess long-term outcome and our post-operative transcatheter vertical vein closure experiences in five patients with repaired total anomalous pulmonary venous connection patients. METHODS A retrospective study was conducted in five cases with an unligated vertical vein following repair of supra-cardiac total anomalous pulmonary venous connection at our hospital from 2011 through 2018. Patients characteristics, cardiac catheterisation findings, surgical, and transcatheter procedural details were retrospectively analysed. RESULTS Transcatheter closure of the unligated vertical vein was technically successful in all the patients. Procedure-related complications were not observed in any of the patients. No long-term complication was found. CONCLUSIONS We suggest that transcatheter closure of the patent vertical vein is an effective and well-tolerated alternative to the surgical approach.
Collapse
|
5
|
Hung DQ, Huy DX, Vo HL, Hien NS. Factors Associated with Early Postoperative Results of Total Anomalous Pulmonary Venous Connection Repair: Findings from Retrospective Single-Institution Data in Vietnam. Integr Blood Press Control 2021; 14:77-86. [PMID: 34103983 PMCID: PMC8179795 DOI: 10.2147/ibpc.s308778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction There are scanty reports of the risk factors for pulmonary hypertensive crisis and low cardiac output syndrome after the operative repair of total anomalous pulmonary venous connection (TAPVC). We aim to evaluate early surgical outcomes of TAPVC and risk factors for pulmonary hypertensive crisis and low cardiac output syndrome. Methods We conducted a retrospective medical record review for all patients undergoing operative repair of TAPVC within 5 years. Outcome variables included pulmonary hypertensive crisis, low cardiac output syndrome and early mortality. Results Of 58 patients, we documented 77.59% supracardiac, 20.69% cardiac and 1.72% mixed site of connection. About 86.21% patients underwent elective surgery, and 13.79% patients required emergency surgery. Incidence rates were 27.59% for pulmonary hypertensive crisis and 6.90% for low cardiac output syndrome. Body weight below 6 kg, pneumonia, tachycardia, hepatomegaly, preoperative pulmonary congestion on chest x-ray, preoperative elevated mean pulmonary artery pressure, preoperative pulmonary venous obstruction, emergency surgery and prolonged aortic cross-clamping time were significant risk factors for postoperative pulmonary hypertensive crisis. Significant risk factors for postoperative low cardiac output syndrome included pneumonia, prolonged duration of preoperative mechanical ventilation and prolonged aortic cross-clamping time. Conclusion The early outcome of surgical repair of TAPVC was acceptable, with 96.55% survival rate. This current analysis suggests that a thorough evaluation of all preoperative and operative characteristics is imperative to achieve best medical and surgical outcomes.
Collapse
Affiliation(s)
- Doan Quoc Hung
- Hanoi Medical University, Hanoi, Vietnam.,Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | | | - Hoang-Long Vo
- Hanoi Medical University, Hanoi, Vietnam.,Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, Vietnam
| | | |
Collapse
|
6
|
Al-Radi OO, Elmahrouk A, Ismail M, Helal A, Hamouda T. Total anomalous pulmonary venous drainage repair: the effect of anatomical type and pulmonary vein stenosis on outcomes. THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-0016-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Surgical repair of total anomalous venous drainage (TAPVD) is lifesaving. The operative mortality is reported between 4 and 35%. Anatomical type, obstructed presentation, associated single ventricle, and heterotaxy syndromes are thought to influence short- and long-term outcomes. The effect of simple versus sutureless repair for primary surgery is unclear. This study reports the outcomes of the surgical repair and the effect of these variables in a contemporary setting.
Results
Between 2011 and 2019, all patients undergoing surgical repair for TAPVD were included. Operative mortality, length of hospital stay, and long-term survival were reported. The effect of anatomical type, surgical technique, obstruction, and associated lesions was assessed. Pearson’s test, Wilcoxson’s test, and generalized linear regression with Poisson distribution were used.
Forty-nine patients from two centers underwent TAPVD repair. The operative mortality was 4%. Postoperative pulmonary vein stenosis occurred in three patients, and reoperation was done in one patient. Survival free from reoperation was 98%, 98%, and 90% at 1, 24, and 60 months in the absence of pulmonary vein stenosis. However, all three patients who developed pulmonary vein stenosis died, at 0.5, 2.7, and 6.3 months of follow-up, respectively. We were unable to detect a significant effect of anatomical type, preoperative obstruction, associated single ventricle, or heterodoxy syndrome on operative mortality or long-term freedom from death or reoperation. Patients who presented with obstruction and infracardiac or supracardiac TAPVD had longer hospital stay.
Conclusion
TAPVD repair outcomes are excellent except for patients who develop postoperative pulmonary venous stenosis. Anatomical type, obstructed presentation, associated single ventricle, or heterotaxy are not significant predictors of survival.
Collapse
|
7
|
Yang L, He X, Lu Y, Huang F, Shi G, Chen H, Zheng J, Zhu Z, Chen P. Integrated model for the prenatal diagnosis and postnatal surgical treatment of total anomalous pulmonary venous connection: A multidisciplinary collaborative experience and preliminary results. J Card Surg 2019; 34:1264-1272. [PMID: 31475761 DOI: 10.1111/jocs.14242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study aimed to evaluate an integrated model for the prenatal diagnosis and postnatal treatment of total anomalous pulmonary venous connection (TAPVC). METHODS From January 2014 to December 2018, 11 patients were considered as a prenatally diagnosed group, who would accept the integrated model for prenatal diagnosis and postnatal treatment of TAPVC. Besides, 25 patients as postnatally diagnosed group underwent emergency surgery during the corresponding period at the same age. The perioperative status, survival and risk factors for death were compared between the two groups. RESULTS In a prenatally diagnosed group, three pregnant women chose termination; eight patients followed the integrated model, and their newborns were rapidly transported to a children's hospital within 24 hours after birth. Other than one patient who was prenatally diagnosed with infracardiac type was later confirmed as a mixed type of TAPVC, the prenatal and postnatal diagnoses of the other seven patients were consistent. The 30-day, 1-year, and 5-year survival rates in the prenatally diagnosed group were 100%, 100%, and 100%, while those in the postnatally diagnosed group were 92%, 87.8%, and 87.8%, without significant difference (P > .05). Although Fisher's exact test indicated that an oxygen saturation <70% at admission might be an independent predictor of mortality (P < .01), none of the risk factors for death were significantly different by multivariate Cox regression analysis. CONCLUSION The integrated model of prenatal diagnosis and postnatal treatment by multidisciplinary collaboration could lead to satisfactory outcomes, and prenatal diagnosis combined with postnatal oxygen saturation evaluation would facilitate early intervention for TAPVC.
Collapse
Affiliation(s)
- Lijuan Yang
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaomin He
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Lu
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fan Huang
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guocheng Shi
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiwen Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghao Zheng
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongqun Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Chen
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
8
|
Joffe DC, Latham GJ, Ross FJ. Current perspectives on treatment of perioperative hemodynamic instability and hypotension. Paediatr Anaesth 2019; 29:457-466. [PMID: 30614162 DOI: 10.1111/pan.13583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022]
Abstract
Overall, there are numerous causes of hypotension in the perioperative period. The approach to definitive treatment must be tailored to the child's unique anatomy and physiology, as well as the current factors presumed to be eliciting the hypotensive state. It is imperative to consider both routine and lesion-specific etiologies to the current hypotensive episode. Lastly, when employing pharmacologic therapy for hypotension, there are often multiple combinations of medications that can reasonably be used to achieve the desired hemodynamic effects.
Collapse
Affiliation(s)
- Denise C Joffe
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Gregory J Latham
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Faith J Ross
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
9
|
Obinata H, Nishibe S, Ishihara Y. Atypical perioperative management for duodenal obstruction in an infant with heterotaxy syndrome: a case report. JA Clin Rep 2018; 4:16. [PMID: 29479560 PMCID: PMC5809575 DOI: 10.1186/s40981-018-0154-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
|
10
|
Twite MD. Sir William Harvey, Congenital Heart Disease and Anesthesia. Semin Cardiothorac Vasc Anesth 2017; 21:121-122. [PMID: 28506196 DOI: 10.1177/1089253217704509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mark D Twite
- 1 Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|