Current topics in surgery for isolated total anomalous pulmonary venous connection

Abstract

Surgical correction of total anomalous pulmonary venous connection (TAPVC) remains a challenge, with reported early mortality rates of up to 20%. In this review article, we describe several topics, including surgery for neonates, diagnoses with multidetector computed tomography (MDCT), and primary sutureless repair. Several studies have reported mortality rates of around 10%, and demonstrated unchanged hospital mortality in neonates, despite improvement of the overall mortality of cohorts including older patients. Previous reports identified a low body weight at the time of the operation, preoperative pulmonary venous obstruction (PVO), and a prolonged cardiopulmonary bypass time as risk factors for hospital mortality. With the development of new technologies, MDCT has become a good diagnostic modality for use in the pre- and post-operative evaluation. MDCT delineates the drainage site of the vertical vein and the atypical vessel into the systemic vein, and it can also evaluate the existence of obstruction in the vertical vein. Following favorable experiences with post-repair PVO, the indications for sutureless repair as a primary operation have been expanded for infants, including those at risk of developing PVO after the repair of TAPVC. Primary sutureless repair has proven especially useful for difficult patient groups, such as those with congenital PVO, infracardiac TAPVC with small pulmonary veins, or mixed-type TAPVC.

Total Anomalous Pulmonary Venous Connection in Children

“…Several studies show a correlation between the type of surgery performed and the risk of postoperative complications. 16,[19][20][21] In our study, intraoperative variables such as cardiopulmonary bypass time and cross-clamp time were not associated with a higher risk of arrhythmias (p >0.05). Late postoperative complications occurred in 2 patients (8%), at 9 and 12 months after the initial surgical procedure, in the form of obstruction.…”

Assessing the recently noted surgical outcome of isolated total anomalous pulmonary venous connection repair: A single‐secondary center experience

“…We did not identify any significant differences between the conventional method and the sutureless technique because there were only four cases in which the sutureless technique was used. Although there are reports that the sutureless technique is less common in postoperative PVS than the conventional methods, there were also reports that there was no significant difference between them . Our hospital has very limited experience with the sutureless technique; thus, it is difficult to assess its usefulness.…”

A rare association of left pulmonary artery sling with right pulmonary hypoplasia and total anomalous pulmonary venous connection

“…Although the outcomes after surgical correction of total anomalous pulmonary venous connection have generally improved over the past several decades with advances in surgical techniques and medical management, surgical repair remains challenging, with early mortality rates reported in the literature ranging from <10 to 20%. 16 Repair during the neonatal period, the presence of pulmonary venous obstruction, mixed or infracardiac total anomalous pulmonary venous connection, a small left atrium, and low body weight at the time of operation are associated with a higher mortality rate. 16 Our case had almost all of these risk factors: neonate, pulmonary venous obstruction, a small left atrium, and a lower body weight.…”

“…16 Repair during the neonatal period, the presence of pulmonary venous obstruction, mixed or infracardiac total anomalous pulmonary venous connection, a small left atrium, and low body weight at the time of operation are associated with a higher mortality rate. 16 Our case had almost all of these risk factors: neonate, pulmonary venous obstruction, a small left atrium, and a lower body weight. In addition to the small left atrium, the giant coronary sinus made the anastomosis between the confluent pulmonary vein and the left atrium unfeasible.…”