Surgical management of progressive pulmonary venous obstruction after repair of total anomalous pulmonary venous connection

Abstract

Progressive pulmonary venous stenosis after repair of total anomalous pulmonary venous connection remains a severe complication when bilateral. The sutureless in situ pericardial repair offers a satisfactory solution, particularly on the right side.

Tomografia computadorizada na avaliação tardia do tratamento cirúrgico da conexão anômala total de veias pulmonares

“…Among these mechanisms are inadequate alignment of the incisions between the CPA and LA, causing shrinkage in the anastomosis, which leads to distortion of PV [16]. Also, some authors attribute the need for reoperation stenosis and intimal hyperplasia with proliferation of thickened inflammatory tissue [17]. In our study, we observed that in some patients, there was a decline of PV caliber, and the LIPV was clearly the most affected.…”

“…It usually manifests itself quickly, leading the patient to reoperation within the first six months after the repair [13]. This need for early approach still remains the cause of high mortality in centers of excellence worldwide [4,5,[13][14][15].…”

“…To avoid this complication, good technical option is opening the CPV in the direction of VV in T or Y, expanding the anastomotic site. This attention should always be in the mind of the surgeon and in surgical patients in the series; such caution was observed, avoiding incisions in PV [17].…”

“…This situation is a late complication of most concern because it has important clinical consequences and compromises the prognosis [4,5].…”

“…Usually, these patients are followed-up with clinical assessment, chest radiography, electrocardiography (ECG) and Holter, and echocardiogram that demonstrates or suggests with color Doppler the presence or absence of reduced caliber of PV [4][5][6][7].…”