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Hogue SJ, Mehdizadeh-Shrifi A, Kulshrestha K, Cnota JF, Divanovic A, Ricci M, Ashfaq A, Lehenbauer DG, Cooper DS, Morales DLS. Birth in the Operating Room for Immediate Cardiac Surgery: A Rare but Effective Strategy. World J Pediatr Congenit Heart Surg 2024:21501351241269881. [PMID: 39252613 DOI: 10.1177/21501351241269881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background: With significant advancements in fetal cardiac imaging, patients with complex congenital heart disease (CHD) carrying a high risk for postnatal demise are now being diagnosed earlier. We sought to assess an interdisciplinary strategy for delivering these children in an operating room (OR) adjacent to a cardiac OR for immediate surgery or stabilization. Methods: All children prenatally diagnosed with CHD at risk for immediate postnatal hemodynamic instability and cardiogenic shock who were delivered in the operating room (OR) between 2012 and 2023 in which the senior author was consulted were included. Results: Eight patients were identified. Six (75%) patients were operated on day-of-life zero, all requiring obstructed total anomalous pulmonary venous return (TAPVR) repair. Of these six patients, 2 (33%) required a simultaneous Norwood procedure, 2 (33%) required pulmonary artery unifocalization and modified Blalock-Taussig-Thomas shunt, and 2 (33%) patients had repair of obstructed mixed TAPVR. The remaining 2 patients potentially planned for immediate surgery had nonimmune hydrops fetalis and went into cardiogenic shock at 12 and 72 hours postnatally, requiring a novel Norwood procedure with left-ventricular exclusion for severe aortic/mitral valve insufficiency. The median ventilation and inpatient durations were 19 [IQR: 11-26] days and 41 [IQR: 32-128] days, respectively. Three(38%) patients required one or more in-hospital reoperations. Subsequent staged procedures included Glenn (n = 5), Fontan (n = 3), biventricular repair (n = 2), ventricular assist device placement (n = 1), and heart transplant (n = 1). Median follow-up was 5.7 [IQR:1.3-7.8] years. The five-year postoperative survival was 88% (n = 7/8). Conclusion: While children with these diagnoses have historically had poor survival, the strategy of birth in the OR adjacent to a cardiac OR where emergent surgery is planned is a potentially promising strategy with excellent clinical outcomes. However, this is a high-resource strategy whose feasibility in any program requires thoughtful assessment.
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Affiliation(s)
- Spencer J Hogue
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Kevin Kulshrestha
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James F Cnota
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison Divanovic
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marco Ricci
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Awais Ashfaq
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David G Lehenbauer
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Wang Z, Ma K, Li S. Long-term outcomes of repair in children with total anomalous pulmonary venous connection. Cardiol Young 2024:1-10. [PMID: 38801142 DOI: 10.1017/s1047951124025204] [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: 05/29/2024]
Abstract
OBJECTIVES The clinical data of patients with total anomalous pulmonary venous connection who underwent repair in our centre in the past 13 years were reviewed. In this study, we systemically reviewed our experience in the optimal surgical strategy for patients with total anomalous pulmonary venous connection, aiming to provide evidence for clinical decision-making. METHODS From January 1, 2009, to December 31, 2021, 122 patients undergoing surgical treatment for total anomalous pulmonary venous connection in our hospital were enrolled. Among them, 18 patients with single ventricle repair were excluded from the study. Multivariate analysis was used to determine the risk factors for early and late death and the risk factors for pulmonary vein obstruction. RESULTS There were 64 males and 40 females. The median age at surgery was 107 days (range, 25 days-788 days), the median weight at surgery was 4.8 kg (range, 3 kg-22 kg), and the median follow-up was 59 months (range, 0-150 months). Seven patients died early after surgery and six died late after discharge. Multivariable analysis indicated that prolonged cardiopulmonary bypass time was the only independent risk factor for early postoperative mortality. Multivariate analysis did not identify risk factors for late death. Emergency surgery, preoperative moderate and severe pulmonary hypertension, and prolonged cardiopulmonary bypass time were independent risk factors for postoperative pulmonary vein obstruction. CONCLUSION Early and long-term late outcomes of repair in patients with total anomalous pulmonary venous connection have been encouraging. Postoperative pulmonary vein obstruction remains a major problem for specialists worldwide. Pulmonary vein obstruction should be considered in children with preoperative emergency surgery, moderate to severe pulmonary hypertension and prolonged cardiopulmonary bypass time, and regular follow-up is necessary.
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Affiliation(s)
- Zhangwei Wang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Kai Ma
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shoujun Li
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
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3
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Wang Z, Ding N, Yi H, Zhu Y, Li Z, Yan D, Li X, Bai S. Prognosis and related risk factors analysis of total anomalous pulmonary venous connection correction. J Card Surg 2022; 37:2524-2535. [PMID: 35652889 DOI: 10.1111/jocs.16652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/17/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was performed to analyze the surgical outcomes of our center biventricular correction with total anomalous pulmonary venous connection (TAPVC) and to explore the risk factors associated with postoperative mortality and postoperative pulmonary venous obstruction (PVO). METHODS In total, 104 patients diagnosed with TAPVC and underwent biventricular correction from January 1, 2009 to December 31, 2021, in Beijing Children's Hospital Affiliated with Capital Medical University were included. The primary endpoints were early and late postoperative mortality and postoperative pulmonary vein obstruction. RESULTS Multivariable analysis indicated that prolonged cardiopulmonary bypass (CPB) time was the only independent risk factor for early postoperative mortality. Emergency surgery, preoperative moderate, and severe pulmonary hypertension (PH), and prolonged CPB time were independent risk factors for postoperative PVO. According to ROC curve analysis, the cut-off value of CPB time for predicting early mortality was 148 min (AUC = 0.916, 95% CI 0.811-1.000). CONCLUSION In the past 12 years, with surgical technique and perioperative management advancement, the prognosis of children treated with TAPVC biventricular correction in our center has generally improved. However, surgical repair remains challenging, and early mortality remains high in children with prolonged CPB time during surgery. Postoperative PVO often occurs in children who underwent emergency surgery, combined with moderate and severe PH and prolonged CPB time.
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Affiliation(s)
- Zhangwei Wang
- Department of Cardiac Surgery, Beijing Children's Hospital, National Children's Medical Center, Capital Medical University, Beijing, China
| | - Nan Ding
- Department of Cardiac Surgery, Beijing Children's Hospital, National Children's Medical Center, Capital Medical University, Beijing, China
| | - Hanlu Yi
- Department of Cardiac Surgery, Beijing Children's Hospital, National Children's Medical Center, Capital Medical University, Beijing, China
| | - Yaobin Zhu
- Department of Cardiac Surgery, Beijing Children's Hospital, National Children's Medical Center, Capital Medical University, Beijing, China
| | - Zhiqiang Li
- Department of Cardiac Surgery, Beijing Children's Hospital, National Children's Medical Center, Capital Medical University, Beijing, China
| | - Daole Yan
- Department of Cardiac Surgery, Beijing Children's Hospital, National Children's Medical Center, Capital Medical University, Beijing, China
| | - Xiaofeng Li
- Department of Cardiac Surgery, Beijing Children's Hospital, National Children's Medical Center, Capital Medical University, Beijing, China
| | - Song Bai
- Department of Cardiac Surgery, Beijing Children's Hospital, National Children's Medical Center, Capital Medical University, Beijing, China
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4
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Okamoto T, Nakano T, Goda M, Oda S, Kado H. Outcomes of systemic-to-pulmonary artery shunt for single ventricular heart with extracardiac total anomalous pulmonary venous connection. Gen Thorac Cardiovasc Surg 2020; 69:646-653. [PMID: 32886275 DOI: 10.1007/s11748-020-01474-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES A few studies have described the outcomes of systemic-to-pulmonary artery shunt (SPS) for functional single ventricular heart with extracardiac total anomalous pulmonary venous connection (TAPVC). This study aimed to examine the outcomes of SPS with extracardiac TAPVC and identify the predictors of mortality before bidirectional Glenn operation (BDG). METHODS Medical records of 41 children with single ventricular heart and extracardiac TAPVC who underwent SPS between 1998 and 2019 were reviewed retrospectively. The median age and body weight at SPS were 36 days and 3.4 kg, respectively. Surgical outcomes and predictors of mortality were investigated. RESULTS Four operative deaths (10%) and 10 late deaths (27%) occurred before BDG. Of all the children, 19 underwent BDG at a median of 10 months since SPS and eight are waiting for BDG. In the multivariate analysis, preoperative pulmonary venous obstruction (p = 0.01) at initial surgery was most predictive of death before BDG. Patients who underwent simultaneous SPS and TAPVC repair were younger, had high preoperative rate of pulmonary venous obstruction, and more deaths before BDG. CONCLUSIONS Survival outcomes of SPS for SVH with extracardiac TAPVC were improved as a whole due to the increase in knowledge and technique of management SPS. However, the patients who have preoperative pulmonary venous obstruction (PVO) and need SPS and TAPVC repair concomitantly in the early postnatal period have poor outcomes and still challenging. In such a case, staged TAPVC repair and SPS may be beneficial.
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Affiliation(s)
- Takuya Okamoto
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Toshihide Nakano
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Masami Goda
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Shinichiro Oda
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Hideaki Kado
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan
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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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Çakır U, Kahvecioğlu D, Alan S, Erdeve Ö, Atasay B, Uçar T, Arsan S, Çakmaklı H, Ertem M, Atalay S. Portal Vein Thrombosis of a Newborn with Corrected Total Anomalous Pulmonary Venous Return. Turk J Haematol 2017; 32:267-70. [PMID: 26376593 PMCID: PMC4563204 DOI: 10.4274/tjh.2013.0428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Total anomalous pulmonary venous return (TAPVR) is a rare and frequently isolated defect identified in 1% to 3% of all congenital heart diseases. To the best of our knowledge, portal vein thrombosis (PVT) associated with TAPVR has not been reported in the literature. We report a successfully managed PVT in a newborn with infracardiac-type TAPVR and review the literature. Anticoagulation therapies were used during the neonatal period to prevent thrombus progression. PVT should be kept in mind in TAPVR patients who have open heart repair with total correction. The treatment in each neonate should be individualized with consideration of the risk/benefit ratio.
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Affiliation(s)
- Ufuk Çakır
- Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey E-mail:
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Respondek-Liberska M, Sokołowski Ł, Słodki M, Zych-Krekora K, Strzelecka I, Krekora M, Maroszyńska I, Moll J, Moll J. Prenatal Diagnosis of TAPVC on Monday, Delivery of Tuesday and Cardiac Surgery at Wednesday - A Model of Perinatal Care in 3rd Trimester in Case of Fetal/Neonatal Critical Heart Defect in Tertiary Center. PRENATAL CARDIOLOGY 2016. [DOI: 10.1515/pcard-2016-0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect (CHD), in which all pulmonary veins connect to the systemic veins or to the right atrium/coronary sinus instead of the left atrium. We present a case report of fetus with prenatally diagnosed isolated infracardiac type of TAPVC in 38th week of gestation. In fetal echocardiographic examination performed in the Department of Prenatal Cardiology, the fetus presented lack of visible pulmonary veins connection to left atrium, abnormal venous confluence behind left atrium, additional vein leading from abdominal cavity to mediastinum and abnormal smooth Doppler blood flow in pulmonary confluence. The accurate prenatal diagnosis allowed to deliver the neonate at term, in tertiary center one day after diagnosis, and to perform surgical reposition of pulmonary veins the following day. The neonate was referred home in a good condition after 28 days of hospitalization. This case is a good example of the value of the 3rd trimester echocardiography.
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Affiliation(s)
- Maria Respondek-Liberska
- 1. Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute
- 2. Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations Lodz, Poland
| | - Łukasz Sokołowski
- 3. Medical University of Lodz, Students Research Circle Prenatal Cardiology
| | - Maciej Słodki
- 1. Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute
- 4. Institute of Health Sciences, The State School of Higher Professional Education in Płock, Poland
| | - Katarzyna Zych-Krekora
- 2. Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations Lodz, Poland
| | - Iwona Strzelecka
- 2. Medical University of Lodz, Department of Diagnoses and Prevention Fetal Malformations Lodz, Poland
- 5. Department of Nursing, Medical
| | - Michał Krekora
- 6. University of Lodz Department of Obstetrics & Gynecology Research Institute of Lodz
| | - Iwona Maroszyńska
- 7. Department of Intensive Care of Neonates and Congenital Malformations, Research Institute Polish Mother's Memorial Hospital
| | - Jadwiga Moll
- 8. Department of Pediatric Cardiology, Research Institute Polish Mother's Memorial Hospital
| | - Jacek Moll
- 9. Department of Pediatric Cardiac Surgery, Research Instiute Polish Mother's Memorial Hospital
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Mądry W, Karolczak MA. Totally anomalous pulmonary venous drainage - supracardiac type: ultrasound assessment of anatomically determined stenosis of the vertical vein collecting pulmonary venous return. J Ultrason 2012; 12:479-86. [PMID: 26675781 PMCID: PMC4603229 DOI: 10.15557/jou.2012.0035] [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: 05/09/2012] [Revised: 06/06/2012] [Accepted: 12/11/2012] [Indexed: 11/29/2022] Open
Abstract
The diagnosis of the congenital heart defects, among others totally anomalous pulmonary venous drainage, is based on echocardiography. While the visualization of intracardiac structures rarely causes significant difficulties, the vessels positioned outside the heart, e.g. the pulmonary veins, are often hidden behind tissues impermeable to ultrasounds, which may necessitate the use of other imaging methods, such as computer tomography, nuclear magnetic resonance or angiocardiography. The serious limitation of these techniques, especially in pediatric age, is the necessity to administer general anesthesia and contrast media. In order to obtain clear images, the appropriate concentration of a contrast agent in the vessels is necessary, which is not always possible in a patient with severe circulatory failure. Therefore, every effort should be made to obtain as much information necessary for treatment determination as possible from echocardiography, in spite of its limitations. A significant morphological factor of totally anomalous pulmonary venous drainage is the connection between the pulmonary and systemic veins, which in the supracardiac type is the vertical vein draining into the left brachiocephalic vein. The narrowing of this connection impedes the return of the blood from the lungs, which leads to the secondary edema and severe, abrupt cardiorespiratory insufficiency. Such a narrowing should be sought for in every case of totally anomalous pulmonary venous drainage since it constitutes an indication for an urgent surgery. On the basis of own experience and information obtained from the pertinent literature, the authors describe the rules and criteria of the diagnosis of this rare supracardiac form of the heart defect with the presence of the vertical vein which may undergo stenosis due to a phenomenon called the anatomical or bronchoarterial vise. It is formed when the vessel “pushes through” a narrow opening bordered by the left pulmonary artery from the inferior side as well as the left main bronchus and the arterial duct or ligament from the superior side. This article describes a technique of echocardiographic test enabling the precise visualization of the vessel's course and the differentiation from a more common variant of the defect – without external stenosis.
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Affiliation(s)
- Wojciech Mądry
- II Katedra i Klinika Kardiochirurgii i Chirurgii Ogólnej Dzieci, Warszawki Uniwersytet Medyczny, Warszawa, Polska
| | - Maciej A Karolczak
- II Katedra i Klinika Kardiochirurgii i Chirurgii Ogólnej Dzieci, Warszawki Uniwersytet Medyczny, Warszawa, Polska
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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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Nakayama Y, Hiramatsu T, Iwata Y, Okamura T, Konuma T, Matsumura G, Suzuki K, Hobo K, Nakanishi T, Kurosawa H, Yamazaki K. Surgical Results for Functional Univentricular Heart With Total Anomalous Pulmonary Venous Connection Over a 25-Year Experience. Ann Thorac Surg 2012; 93:606-13. [DOI: 10.1016/j.athoracsur.2011.09.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/25/2011] [Accepted: 09/02/2011] [Indexed: 10/14/2022]
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