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Luca AC, Curpăn AȘ, Manea RS, Butnariu LI, Țarcă E, Starcea IM, Roșu ST, Mîndru DE, Macsim E, Adumitrăchioaiei H, Pădureț IA. Total Anomalous Pulmonary Venous Return in the Time of SARS-CoV-2-Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020387. [PMID: 36832516 PMCID: PMC9955405 DOI: 10.3390/children10020387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
The management of children with complex and life-threatening heart malformations became a clinical conundrum during the SARS-CoV-2 pandemic. The pathophysiological features of the new coronavirus infection have raised major dilemmas regarding the postoperative evolution of an infected patient, and the epidemiological limitations have tightened the criteria for selecting cases. We present the case of a newborn diagnosed with total anomalous pulmonary venous return (TAPVR) who underwent surgical repair of the defect with favorable outcome, despite a prior diagnosis of SARS-CoV-2 infection. We discuss the medical and surgical management of TAPVR, highlighting possible management difficulties brought by the SARS-CoV-2 pandemic.
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Affiliation(s)
- Alina-Costina Luca
- Department of Pediatrics, Faculty of Medicine, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Alexandrina-Ștefania Curpăn
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, 700505 Iasi, Romania
- Correspondence:
| | - Raluca-Stefania Manea
- Department of Pediatrics, Faculty of Medicine, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, University Street, No 16, 700115 Iasi, Romania
| | - Elena Țarcă
- Department of Surgery II—Pediatric Surgery, ”Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iuliana Magdalena Starcea
- Nephrology Clinic, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Solange Tamara Roșu
- Emergency Room, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Dana Elena Mîndru
- Department of Pediatrics, Faculty of Medicine, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Macsim
- Radiology Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Heidrun Adumitrăchioaiei
- Department of Pediatrics, Faculty of Medicine, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Ioana Alexandra Pădureț
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
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Swartz MF, Meagher C, Yoshitake S, Atallah-Yunes N, Angona R, Cholette JM, Alfieris GM. Pulmonary Venous Gradients in Healthy Controls and Following the Repair of Total Anomalous Pulmonary Venous Return. Pediatr Cardiol 2023; 44:325-332. [PMID: 35986764 DOI: 10.1007/s00246-022-02986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023]
Abstract
The percent of children who can achieve a normal and physiologic pulmonary venous gradient and flow following the repair of Total Anomalous Pulmonary Venous Return (TAPVR) is not known. Pulmonary venous confluence gradients from infants with supra-, infra-, or mixed TAPVR, repaired using a direct anastomotic connection were measured. Data from age, weight, and gender-matched controls established the normal pulmonary venous gradient range (0.30-0.94 mmHg). TAPVR subjects were divided into three groups: (I) pulmonary venous gradient < 2 × normal with multiphasic flow (II) pulmonary venous gradient > 2 × normal with multiphasic flow, and (III) pulmonary venous gradient > 2 × normal with monophasic flow. From 63 children following TAPVR repair and 63 matched controls, pulmonary venous gradients were significantly lower [0.5 mmHg (IQR:0.4, 0.6) vs 1.6 mmHg (IQR:1.0, 2.4); p < 0.001], and multiphasic flow more frequent (100 vs. 84.1%; p = 0.001) within the control group. There were 38 children (60.3%) in group I, 15 (23.8%) in group II, and 10 (15.8%) in group III. Children in Group I were significantly older at the time of repair, had shorter cardiopulmonary bypass times, and did not utilize deep hypothermic circulatory arrest (DHCA). Multivariate analysis confirmed that avoiding DHCA [Odds Ratio 0.931 (0.913,0.994; p = 0.002)] and shorter cardiopulmonary bypass times [Odds Ratio 0.962 (0.861,0.968; p = 0.02)] during repair were associated with the lowest pulmonary venous gradients and multiphasic flow. Following TAPVR repair with a direct anastomosis, the majority of children can achieve a gradient two times normal or less with multiphasic pulmonary venous flow.
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Affiliation(s)
- Michael F Swartz
- Pediatric Cardiac Consortium of Central New York, Rochester, USA.
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA.
| | - Cecilia Meagher
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - Shuichi Yoshitake
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA
| | - Nader Atallah-Yunes
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - Ron Angona
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA
| | - Jill M Cholette
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - George M Alfieris
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
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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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Llerena-Velastegui J. Emergency surgical treatment of total anomalous pulmonary venous connection. J Card Surg 2022; 37:4009. [PMID: 36098350 DOI: 10.1111/jocs.16930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
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Zhang H, Shi G, Chen H. Risk factors for postoperative pulmonary venous obstruction after surgical repair of total anomalous pulmonary venous connection: a systemic review and meta-analysis. Interact Cardiovasc Thorac Surg 2022; 35:6609775. [PMID: 35713512 PMCID: PMC9270848 DOI: 10.1093/icvts/ivac162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/21/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Han Zhang
- Department of Cardiothoracic Surgery, Congenital Heart Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Guocheng Shi
- Department of Cardiothoracic Surgery, Congenital Heart Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Huiwen Chen
- Department of Cardiothoracic Surgery, Congenital Heart Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
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Zhao L, Pan Z, Wu C, Shen L, Wu Y. Sutureless Technique for Primary Total Anomalous Pulmonary Venous Connection Repair: An Updated Meta-Analysis. Front Cardiovasc Med 2022; 9:890575. [PMID: 35571166 PMCID: PMC9095923 DOI: 10.3389/fcvm.2022.890575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background An updated meta-analysis was performed to explore the clinical outcomes following the sutureless repair in patients with total anomalous pulmonary venous connection (TAPVC) and compare outcomes between the sutureless technique and conventional surgery. Methods A systematic search of PubMed, Ovid-Embase, and Cochrane Library (CENTRAL) for relevant published studies that reported the clinical outcomes of the sutureless technique in children with TAPVC was performed in February 2022. The publication language was restricted to English. Results Eleven studies were included involving 771 patients in total. Following the sutureless technique, the incidences of postoperative pulmonary venous obstruction (PVO) and reoperations due to PVO were 3.3% [95% confidence interval (CI), 1.3–5.3%] and 1.8% (95% CI, 0.3–3.3%), respectively. The early and late mortality rates were 3.2% (95% CI, 1.0–5.3%) and 2.5% (95% CI, 0.7–4.3%), respectively. Compared with conventional surgery, the sutureless technique significantly reduced the incidences of postoperative PVO [odds ratio (OR), 0.16; 95% CI, 0.08–0.33; P < 0.00001], reoperations due to PVO (OR, 0.25; 95% CI, 0.10–0.63; P = 0.003), and early mortality (OR, 0.40; 95% CI, 0.21–0.79; P = 0.008). However, no significant difference was found between conventional surgery and the sutureless technique concerning late mortality (OR, 0.63; 95% CI, 0.13–3.00; P = 0.58). Conclusion The sutureless technique is superior to conventional surgery for the primary repair of TAPVC concerning postoperative PVO, reoperations due to PVO, and early mortality. However, the level of evidence is of low quality. Prospective cohort studies or randomized control trials (RCTs) should be performed to evaluate the effectiveness of sutureless techniques for primary TAPVC repair.
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Affiliation(s)
- Lu Zhao
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Lianju Shen
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
- *Correspondence: Lianju Shen,
| | - Yuhao Wu
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Yuhao Wu,
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Sohaib M, Nadeem A. "Letter to the Editor: Emergency surgical treatment of total anomalous pulmonary venous connection". J Card Surg 2022; 37:1804-1805. [PMID: 35293651 DOI: 10.1111/jocs.16405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Muhammad Sohaib
- Department of Medicine, Allama Iqbal Medical College, Lahore, Punjab, Pakistan
| | - Arsalan Nadeem
- Department of Medicine, Allama Iqbal Medical College, Lahore, Punjab, Pakistan
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