Cardiac function in total anomalous pulmonary venous return before and after surgery.

Abstract

Cardiac performance was evaluated in 12 infants with isolated total anomalous pulmonary venous return. Four had significant pulmonary venous obstruction and severe pulmonary hypertension (group A). Eight had no obvious venous obstruction, and the pulmonary pressures were lower (group B). In all subjects, right ventricular end-diastolic volume was increased (197% of predicted normal) and its ejection fraction was normal. Left ventricular volume was, generally speaking, still in the normal range (87% of predicted normal); however, its ejection fraction was reduced (0.57 vs normal of 0.73) and left ventricular output was low (3.08 L/min/m2 vs normal of 3.98). Left atrial volume was consistently small (53% of predicted normal) with an appendage of normal size. The infants in group A had smaller chamber volumes/m2 BSA than those in group B. Left atrial function was abnormal, characterized by reduced reservoir function and a greater role as "conduit" from right atrium to left ventricle. Left atrial size was not found to be critical in the surgical repair of TAPVR. Cardiac function is restored to normal following surgery.

Total anomalous pulmonary venous connection (surgical technique, early and late results).

“…Recent haemodynamic studies have shown normal cardiac function after surgical correction performed in infancy (Mathew et al, 1977), and add further support to this policy. A comparison of haemodynamic studies in patients who have undergone total correction at a later age, with those who have been corrected in infancy, is awaited with interest.…”

The value of early repair for total anomalous pulmonary venous drainage

“…with that collected by Mathew et al . [17] and Nakazawa et al . [20] suggests : (a) preoperatively, the left ventricular size, ejection fraction, and systolic output are often decreased ; (b) these decreases probably result from a decreased volume load to the left ventricle ; (c) pulmonary symptoms result from venous obstruction and not from ventricular dysfunction ; and (d) decreased left ventricular size and function do not affect operative mortality and are reversed with early repair.…”

Open vertical vein in non-obstructed supracardiac TAPVC: merits and fate

“…[12][13][14] Two explanations have been proposed: the large left-to-right shunt under-fills the left-sided chambers; 15 and during embryologic development, the common pulmonary vein fails to fuse with the LA body. 16 Some surgical approaches using patch augmentation to increase LA capacity were designed to obviate this shortcoming.…”