Conventional and sutureless techniques for management of the pulmonary veins: Evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies

Yun, Tae-Jin; Coles, John G.; Konstantinov, Igor E.; Al‐Radi, Osman O.; Wald, Rachel M.; Guerra, Vitor; Oliveira, Nilto C. De; Arsdell, Glen S. Van; Williams, William G.; Smallhorn, Jeffrey; Caldarone, Christopher A.

doi:10.1016/j.jtcvs.2004.08.043

Cited by 163 publications

(103 citation statements)

References 14 publications

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“…It also is probable that reoperation rates have increased commensurate with the increase in the number and level of complex repairs undertaken in the recent era and a concomitant decrease in the threshold for reintervention. Sutureless techniques for recurrent PVO as described by our group 23,24 and others 25 have demonstrated superior outcomes over conventional surgical (eg, pulmonary venous endarterectomy or patch enlargement) and catheter-based methods. 25,26 A recent study from our institution 24 reported acceptable freedom from death and reoperation with extension of the sutureless technique to patients with primary pulmonary venous anomalies.…”

Section: Reoperationmentioning

confidence: 94%

“…Sutureless techniques for recurrent PVO as described by our group 23,24 and others 25 have demonstrated superior outcomes over conventional surgical (eg, pulmonary venous endarterectomy or patch enlargement) and catheter-based methods. 25,26 A recent study from our institution 24 reported acceptable freedom from death and reoperation with extension of the sutureless technique to patients with primary pulmonary venous anomalies. Further studies are needed to determine the utility of novel techniques in the heterogeneous spectrum of TAPVC.…”

Section: Reoperationmentioning

confidence: 94%

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Factors Associated With Mortality and Reoperation in 377 Children With Total Anomalous Pulmonary Venous Connection

et al. 2007

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Background-We sought to determine era-specific changes in the incidence of mortality and reoperation in children with total anomalous pulmonary venous connection. Methods and Results-We reviewed the records of 377 children presenting from 1946 to 2005 with total anomalous pulmonary venous connection. Multivariable parametric regression models determined the incidence and risk factors for death and reoperation after repair. Pulmonary venous connection was supracardiac in 44%, infracardiac in 26%, cardiac in 21%, and mixed in 9%. Pulmonary venous obstruction was present in 48% at presentation, most frequently with infracardiac connection type (PϽ0.001). In total, 327 patients were repaired (median age, 1.7 months). Overall survival from repair was 65Ϯ6% at 14 years, with a current survival of 97%. Significant (PϽ0.01) incremental risk factors for postrepair death were cardiac connection type, earlier operation year, younger age at repair, use of epinephrine postoperatively, and postoperative pulmonary venous obstruction. More recent operation year was associated with younger age at repair (PϽ0.001), decreased use of deep hypothermic circulatory arrest (PϽ0.001), and use of specific drugs postoperatively (PϽ0.001). Risk-adjusted estimated 1-year survival for a patient repaired at birth with unfavorable morphology in 2005 is 37% (95% CI, 8 to 80) compared with 96% (95% CI, 91 to 99) for a patient with favorable morphology repaired at 1 year of age. Freedom from reoperation was 82Ϯ6% at 11 years after repair, with increased risk associated with mixed connection type (Pϭ0.04) and postoperative pulmonary venous obstruction (PϽ0.001). Conclusions-Mortality after total anomalous pulmonary venous connection repair has decreased but remains highest in young patients and in those with cardiac connection type or pulmonary venous obstruction. Unfavorable anatomic characteristics remain important determinants of postrepair survival despite improved perioperative care. (Circulation.

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Section: Reoperationmentioning

confidence: 94%

Section: Reoperationmentioning

confidence: 94%

Factors Associated With Mortality and Reoperation in 377 Children With Total Anomalous Pulmonary Venous Connection

et al. 2007

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“…A technique by which the pericardium around the pulmonary veins is attached to the left atrium avoids any stitches in the cut edges of the pulmonary veins and is now considered the best approach. [27][28][29] Limited experience suggests that this sutureless marsupialization may be superior to previous approaches that used direct anastomosis after resection of stenotic segments or patching of the stenotic veins. Overall, freedom from reoperation or death at 5 years, however, is still only Ϸ50%.…”

Section: Treatment and Prognosis Of Pediatric Pulmonary Vein Stenosismentioning

confidence: 99%

“…Overall, freedom from reoperation or death at 5 years, however, is still only Ϸ50%. 28,29 Patients with milder degrees of stenosis and stenosis of only 1 or 2 pulmonary veins clearly have a better prognosis. Progressive pulmonary vein stenosis isolated to 1 lung may be survivable even though flow studies demonstrate little or no flow to the involved lung.…”

Section: Treatment and Prognosis Of Pediatric Pulmonary Vein Stenosismentioning

confidence: 99%

Congenital and Acquired Pulmonary Vein Stenosis

2007

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“…The purpose of this approach is to reduce trauma to the pulmonary veins by reducing any stimulus for the regrowth of obstructive tissue (2). Unfortunately, the five-year survival and reoperation-free rate is only 50% (10,12). Other surgical interventions include balloon dilation and stent insertion (2).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Vein Stenosis: Case Report and Literature Review

Amin

Kwon

Moayedi

et al. 2009

Canadian Respiratory Journal

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BACKGROUND: Pulmonary vein stenosis is a rare cause of pulmonary hypertension, with variable onset and presentation. One or more of the four pulmonary veins can be primarily or secondarily affected. A five-month-old girl presented with respiratory distress, lethargy and cyanosis requiring intubation.METHODS: Echocardiography showed right ventricular dilation, a right ventricular systolic pressure of 97 mmHg, decreased ejection fraction and turbulent flow at the left atrium. Cardiac catheterization revealed stenosis of the left-sided pulmonary veins, for which she underwent a Coles procedure.RESULTS: Postoperatively, there was a transient improvement in the patient’s pulmonary hypertension but she subsequently deteriorated. Her prognosis was considered bleak, and a decision was made with the family to withdraw care.CONCLUSION: Pulmonary vein stenosis is a rare cause of pulmonary hypertension, and is associated with significant morbidity and mortality. Surgical intervention may be of benefit in selected cases. It stands to reason that any treatment will have the best chance of success if completed before the pulmonary hypertension becomes fixed. Early diagnosis depends on a high index of clinical suspicion.

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Conventional and sutureless techniques for management of the pulmonary veins: Evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies

Abstract: The sutureless technique for postrepair pulmonary vein stenosis is associated with encouraging midterm results. Extension of the indications for the technique to primary repair appears safe with the development of simple intraoperative maneuvers.

Cited by 163 publications

References 14 publications

Factors Associated With Mortality and Reoperation in 377 Children With Total Anomalous Pulmonary Venous Connection

Factors Associated With Mortality and Reoperation in 377 Children With Total Anomalous Pulmonary Venous Connection

Congenital and Acquired Pulmonary Vein Stenosis

Pulmonary Vein Stenosis: Case Report and Literature Review

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