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Bagaria V, Lahari B, Jagannath BR, Hiremath CS. Total Anomalous Pulmonary Venous Connection in Adults: Should We Offer Surgery? World J Pediatr Congenit Heart Surg 2024; 15:319-324. [PMID: 38654425 DOI: 10.1177/21501351241232072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: We aim to determine the surgical outcomes of adult patients with total anomalous pulmonary venous connection (TAPVC) and examine the regression of pulmonary artery (PA) pressures after the procedure. Methods: We reviewed the hospital records from 2003 to 2022 and identified 49 adult patients with TAPVC. We assessed their surgical outcomes and the trend of PA pressures after the procedure. Continuous data are presented as mean ± SD or median (interquartile range) and categorical variables are presented as percentages. Results: The median age of the patients was 23 years (range 18-42) and 31 (63.3%) were male. Thirty-six patients (73.5%) had supracardiac TAPVC. The mean systolic PA pressure was 65.8 ± 16.4 mm Hg and it decreased by 47.9% (34%, 61.8%) after surgery. Moderate or more tricuspid regurgitation was seen in 27 (55.1%) patients before surgery; however, it was present in only 3 (6.1%) patients during early follow-up. There was no intraoperative or 30-day mortality, and the median hospital length of stay was six days. Long-term follow-up data were available for 29 patients with the average duration of follow-up being 5.6 years (range 6 months to 15 years) and the mean systolic PA pressures of this cohort was 29.8±7.9 mm Hg. Forty-six (93.1%) patients were asymptomatic; four women had uneventful pregnancies and delivered healthy children. Conclusion: Surgical repair of the naturally selected group of adult TAPVC patients can be performed safely with good results. Regression in flow-related pulmonary hypertension and an improvement in functional quality of life are seen in nearly all patients.
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Affiliation(s)
- Vivek Bagaria
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
- Department of Congenital Cardiac Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Badragiri Lahari
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - B R Jagannath
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - C S Hiremath
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
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Vijayan J, Venkataswamy M, Subramanian A, Kumar HVJ. Ebstein's anomaly with total anomalous pulmonary venous connection in an adult. Indian J Thorac Cardiovasc Surg 2024; 40:369-372. [PMID: 38681710 PMCID: PMC11045694 DOI: 10.1007/s12055-023-01664-8] [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: 09/23/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 05/01/2024] Open
Abstract
Ebstein's anomaly is a rare congenital cardiac disease which is often associated with various other cardiac anomalies. However, its association with total anomalous pulmonary venous connection is extremely rare with only one case reported so far in the English literature. We report the first successful surgical correction of both Ebstein's anomaly and total anomalous pulmonary venous connection in an adult patient. Such complex scenarios may pose unique challenges in management which require a judicious approach. Supplementary information The online version contains supplementary material available at 10.1007/s12055-023-01664-8.
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Affiliation(s)
- Jeeva Vijayan
- Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Main Road, Phase 3, Jayanagar 9th Block, Bangalore, 560069 Karnataka India
| | - Manjunath Venkataswamy
- Department of Cardiac Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Main Road, Phase 3, Jayanagar 9th Block, Bangalore, 560069 Karnataka India
| | - Anand Subramanian
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Main Road, Phase 3, Jayanagar 9th Block, Bangalore, 560069 Karnataka India
| | - Honnakere Venkataiya Jayanth Kumar
- Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Main Road, Phase 3, Jayanagar 9th Block, Bangalore, 560069 Karnataka India
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Prakash A, Jhalani I, Darbari A, Kumar A. A Case of Late Presentation of Supracardiac Total Anomalous Pulmonary Venous Connection in an Adult. J Cardiovasc Echogr 2023; 33:202-205. [PMID: 38486695 PMCID: PMC10936703 DOI: 10.4103/jcecho.jcecho_62_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/27/2023] [Indexed: 03/17/2024] Open
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare cyanotic congenital heart disease and their survival into adulthood is even rarer. Here, we present the case of a 26-year-old female who was incidentally diagnosed with a case of supracardiac TAPVC during her pregnancy. All four pulmonary veins were joining to form a common venous confluence which drained into a left-sided vertical vein which drained into the innominate vein.
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Affiliation(s)
- Avinash Prakash
- Department of Cardiothoracic and Vascular Surgery, AIIMS, Rishikesh, Uttarakhand, India
| | - Ishan Jhalani
- Department of Cardiothoracic and Vascular Surgery, AIIMS, Rishikesh, Uttarakhand, India
| | - Anshuman Darbari
- Department of Cardiothoracic and Vascular Surgery, AIIMS, Rishikesh, Uttarakhand, India
| | - Ajay Kumar
- Department of Cardiothoracic and Vascular Surgery, AIIMS, Rishikesh, Uttarakhand, India
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Bae Y, Jang WS, Song K. Surgical correction of total anomalous pulmonary venous return in an adult patient. J Cardiothorac Surg 2022; 17:237. [PMID: 36123587 PMCID: PMC9487107 DOI: 10.1186/s13019-022-01990-9] [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: 06/13/2022] [Accepted: 08/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Total anomalous pulmonary venous return (TAPVR) is rare congenital heart disease. Most TAPVRs require surgical corrections in the neonatal period and survival to adulthood without surgical correction is extremely rare. Most untreated patients with large atrial septal defects and no pulmonary venous obstruction have pulmonary vascular damage from pulmonary over circulation. Case presentation 44-year-old TAPVR patient admitted to our medical center. A snowman-shaped heart, including cardiomegaly and an increase in pulmonary blood flow, was seen in the chest X-ray. A large-sized (around 3 cm) atrial septal defect with dilated right atrium, right ventricle, and pulmonary artery was detected on echocardiography. Heart computed tomography was performed for further evaluation, and supra-cardiac type TAPVR without any obstructive lesion was identified. Conclusions TAPVR in an adult patient is extremely rare, and this patient was treated successfully with surgical correction and is doing well. A sinus rhythm and mild mitral valve regurgitation have remained during 2.5 years of outpatient follow-up.
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Affiliation(s)
- Yohan Bae
- Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| | - Woo Sung Jang
- Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
| | - Kyungsub Song
- Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
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Talwar S, Arora Y, Gupta SK, Kothari SS, Ramakrishnan S, Saxena A, Choudhary SK. Total Anomalous Pulmonary Venous Connection Beyond the First Decade of Life. World J Pediatr Congenit Heart Surg 2019; 10:185-191. [PMID: 30841831 DOI: 10.1177/2150135118822792] [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: 11/16/2022]
Abstract
OBJECTIVE We report our experience with surgery for total anomalous pulmonary venous connection (TAPVC) beyond first decade of life. METHODS Between January 1987 and July 2017, 98 patients ≥ten years underwent TAPVC repair. Their detailed case-records were analyzed. RESULTS Mean age was 19.05 (± 12.8; median 18) years. Anatomic subtypes were supracardiac (n = 62), cardiac (n = 20), and mixed (n = 16). An atrial septal defect (ASD) was present in all. Severe tricuspid valve regurgitation was present in four patients and severe rheumatic mitral regurgitation was present in one. On preoperative cardiac catheterization, mean pulmonary artery pressure was 67 ± 15.6 mm Hg (median 58; range 37-96). Mean pulmonary vascular resistance was 5.6 ± 3.9 Woods units·m2 (median 4.7, range 2.9-11.8). Twenty-five patients had moderate and eight had severe pulmonary arterial hypertension. Right ventricular dysfunction was present in eight patients. At repair, a small ASD was left open in 87 patients while in 11 patients, the ASD was closed using a unidirectional valved patch. Follow-up was available for 90 (92%) patients. There were no late deaths over a mean follow-up of 163 ± 103.98 months (median 163, range 1-362). Eighty-two patients were in NYHA class I and eight were in class II. Right ventricular function normalized in 82 patients while 80 patients had reduction in pulmonary artery pressure. Event-free survival was 94.2% at 5 years, 92.3% at 10 years, and 90% at 20 and 30 years. CONCLUSIONS Outcomes of surgical repair for TAPVC beyond first decade of life are satisfactory. Close follow-up, however, is necessary for possible persistence of pulmonary arterial hypertension.
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Affiliation(s)
- Sachin Talwar
- 1 Departments of Cardiothoracic and Vascular Surgery, Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Arora
- 1 Departments of Cardiothoracic and Vascular Surgery, Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- 2 Departments of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- 2 Departments of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anita Saxena
- 2 Departments of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- 1 Departments of Cardiothoracic and Vascular Surgery, Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Talwar S, Keshri VK, Choudhary SK, Gupta SK, Ramakrishnan S, Juneja R, Saxena A, Kothari SS, Airan B. Surgical strategies for patients with congenital heart disease and severe pulmonary hypertension in low/middle-income countries. HEART ASIA 2015; 7:31-7. [PMID: 27326218 DOI: 10.1136/heartasia-2015-010645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/02/2015] [Accepted: 09/18/2015] [Indexed: 11/04/2022]
Abstract
In this review, we discuss specific surgical strategies that are used in patients with congenital heart disease and severe pulmonary arterial hypertension. Our own experience, with the use of unidirectional valved patches in managing these patients, is also discussed in detail.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Vikas Kumar Keshri
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Saurabh Kumar Gupta
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | | | - Rajnish Juneja
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Anita Saxena
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Shyam Sunder Kothari
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
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Naha K, Vivek G, Shetty RK, Nayak K. Late presentation of TAPVC with multiple cerebral abscesses. BMJ Case Rep 2013; 2013:bcr-2013-009778. [PMID: 23845677 DOI: 10.1136/bcr-2013-009778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 24-year-old man, presenting with fever, headache, vomiting and seizures, subsequently diagnosed with cyanotic congenital heart disease. Evaluation revealed non-obstructive supracardiac total anomalous pulmonary venous connection (TAPVC) as the underlying disorder. Surprisingly, the patient denied any past cardiac symptoms. Presentation in adulthood is infrequent for TAPVC, and primary manifestation with cerebral abscesses is still more unusual.
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Affiliation(s)
- Kushal Naha
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
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Nabati M, Bagheri B, Habibi V. Coincidence of total anomalous pulmonary venous drainage to the superior vena cava, common atrium, and single ventricle: a very rare condition. Echocardiography 2013; 30:E98-101. [PMID: 23360092 DOI: 10.1111/echo.12141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Single ventricle defects, including inflow emptying into 1 ventricle, occur at an incidence of 0.05-0.1 per 10,000 live births. The association of total anomalous pulmonary venous drainage (TAPVD) with single ventricle defects is a risk factor for poor outcome. Conversely, common atrium, a rare congenital anomaly, is an endocardial cushion defect. We present a rare case of an unoperated patient with coincidence of a single ventricle defect, TAPVD with direct drainage from the pulmonary veins into the superior vena cava, and common atrium. To the best of our knowledge, such a case has not been previously reported in the literature.
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Affiliation(s)
- Maryam Nabati
- Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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Misra S, Koshy T, Kumar Dash P. Supracardiac Total Anomalous Pulmonary Venous Connection in an Adult Patient: Role of Transesophageal Echocardiography. Echocardiography 2011; 28:925-8. [DOI: 10.1111/j.1540-8175.2011.01450.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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