A suggested new surgical classification for mixed totally anomalous pulmonary venous connection

Abstract

The morphologic variations of mixed totally anomalous pulmonary venous connection are many and varied. In this review, we give an account of all cases previously described as mixed totally anomalous pulmonary venous connection, analyzing in detail those cases where an accurate anatomical description was provided. We identified 182 suitable cases, from 54 investigations, and reviewed the clinical presentation, anatomic variations, diagnostic features, and management of the patients described.Cross-sectional echocardiography, and cardiac catheterization, provided the necessary diagnostic information, and defined the anatomy before surgery in 139 patients. Magnetic resonance imaging and computerized tomographic angiography had been used for further clarification of the pulmonary venous anatomy. An obstructive pattern of drainage, involving one or more pulmonary veins, had been described in over half of the patients. We then grouped the lesions into categories that have a bearing on the appropriate surgical approach, discussing the appropriate repair for each group. For the overall group, the operative mortality remains high, at 22.9%. We submit that an increased appreciation of various types of mixed totally anomalous pulmonary venous connection may well contribute to improved future surgical management.

Mixed Type Total Anomalous Pulmonary Venous Connection in a Newborn

“…In Press(In Press):e62512. symptoms of pulmonary congestion and right heart failure are expected (4,5). Total anomalous pulmonary vein connection is the disease in which structural changes of pulmonary circulation including arterial wall thickness is present in all types.…”

Total anomalous pulmonary venous return repair in adult patients

“…Тип IV (смешанный) представлен комбинацией вари-антов дренажа легочных вен, систематизированных U. Chowdhury и соавт. [2,3] по трем группам: 1-я груп-па -(2+2), 2-я -(3+1), 3-я -(комбинации вариантов ТАДЛВ). В структуре ТАДЛВ частота I, II, III и IV типов составляет 46-48,6; 15,9-26; 24-26,1 и 5-10% соответ-ственно [4,14,24].…”

Mixed Type of Total Anomalous Pulmonary Venous Connection: Outcomes and Novel Classification

“…Accurate diagnosis, especially regarding how all four pulmonary veins drain, has been emphasized as a critical factor of achieving improved results. We referenced the classi cation of mixed TAPVC subtypes proposed by Chowdhury et al 4 and propose a new classi cation based on our experience.…”

“…In some series, the mortality rate of patients with mixed TAPVC is still high 2 , but because of the rarity of this condition, few reports have focused exclusively on this subtype, and it is di cult to derive enough experience regarding surgery. A useful classi cation system for mixed type TAPVC that can indicate a suitable surgical approach is di cult to formulate due to the variability of the pulmonary venous connections, although one classi cation for subtypes of mixed TAPVC has been proposed 3,4 . The diagnosis and treatment of mixed TAPVC are still challenging and can be daunting.…”