Technical modifications for improved results in total anomalous pulmonary venous drainage

Wilson, William R.; Ilbawi, Michel N.; DeLeon, Serafin Y.; Quinones, Jose A.; Arcilla, René A.; Sulayman, Rabi; Idriss, Farouk S.

doi:10.1016/s0022-5223(19)34908-6

Cited by 35 publications

(25 citation statements)

References 17 publications

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“…Overall, we found better mid-term outcomes (the early mortality rate and the incidence of postoperative PVO were both 6.9%) than have been reported in previous studies, which reported mortality rates of 10% to 50% [ 2 – 5 ] and PVO morbidity rates of 8% to 54% [ 6 – 8 ]. Although our study was performed in a single institution and excluded patients with complex TAPVR, we report favorable overall outcomes.…”

Section: Discussionsupporting

confidence: 50%

“…The in situ (internal) technique is carried out transatrially and transseptally [ 9 – 11 ]. This approach is similar to the type II repair described by Wilson et al [ 8 ]. With the heart in a normal anatomic position and without retracting the myocardium, we performed a right atriotomy with an extended incision through the interatrial septum into the posterior wall of the left atrium (LA).…”

Section: Methodsmentioning

confidence: 99%

“…However, surgical intervention for TAPVR remains associated with an increased risk of early mortality, with early postoperative mortality rates of 10% to 50% [ 2 – 5 ]. Pulmonary venous obstruction (PVO)—the most crucial complication after TAPVR repair—has been reported to occur in 8% to 54% of cases [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Surgery for Total Anomalous Pulmonary Venous Return without Total Circulatory Arrest

Lee

Cho

Kwon

et al. 2016

Korean J Thorac Cardiovasc Surg

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BackgroundRecent developments in surgical techniques and hospital care have led to improved outcomes following total anomalous pulmonary venous return (TAPVR) repair. However, the surgical repair of TAPVR remains associated with a high risk of mortality and need for reoperation. We conducted this retrospective study to evaluate mid-term outcomes following in situ TAPVR repair without total circulatory arrest (TCA), and to identify the risk factors associated with surgical outcomes.MethodsWe retrospectively reviewed 29 cases of surgical intervention for TAPVR conducted between April 2000 and July 2015. All patients were newborns or infants who underwent in situ TAPVR repair without TCA.ResultsFour anatomic subtypes of TAPVR were included in this study: supracardiac (20 cases, 69.0%), cardiac (4 cases, 13.8%), infracardiac (4 cases, 13.8%), and mixed (1 case, 3.4%). The median follow-up period for all patients was 42.9 months. Two (6.9%) early mortalities occurred, as well as 2 (6.9%) cases of postoperative pulmonary venous obstruction (PVO). Preoperative ventilator care (p=0.027) and preoperative PVO (p=0.002) were found to be independent risk factors for mortality.ConclusionIn situ repair of TAPVR without TCA was associated with encouraging mid-term outcomes. Preoperative ventilator care and preoperative PVO were found to be independent risk factors for mortality associated with TAPVR repair.

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Section: Discussionsupporting

confidence: 50%

Section: Methodsmentioning

confidence: 99%

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Outcomes of Surgery for Total Anomalous Pulmonary Venous Return without Total Circulatory Arrest

Lee

Cho

Kwon

et al. 2016

Korean J Thorac Cardiovasc Surg

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“…That we were able to identify only 182 patients amongst 1,826 described as having repair of totally anomalous pulmonary venous connection underscores the rarity of this lesion, and the need for a high index of suspicion. Our review of the pertinent literature reveals a wide spectrum of anatomical and pathological presentation, many different technical aspects of surgical repair, and an increased operative risk when multiple terminations are present than when there is single termination 1 , 2 , 5 – 7 , 12 , 20 , 27 , 32 , 50 , 51 …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2007

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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.

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“…Pulmonary vein (PV) stenosis carries a poor prognosis due to the difficulty of primary surgical repair and the subsequent risk of recurrent obstruction [ 1 - 6 ]. Pulmonary vein stenosis occurs as a complication in a significant fraction of patients post-repair [ 7 ], [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of pulmonary veins after atrio-pericardial anastomosis by cardiovascular magnetic resonance

Greenway

Yoo

Baliulis

et al. 2011

Journal of Cardiovascular Magnetic Resonance

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BackgroundThe atrio-pericardial anastomosis (APA) uses a pericardial pouch to create a large communication between the left atrium and the pulmonary venous contributaries in order to avoid direct suturing of the pulmonary veins during the repair of congenital cardiac malformations. Post-operative imaging is routinely performed by echocardiography but Cardiovascular Magnetic Resonance (CMR) offers excellent anatomical imaging and quantitative information about pulmonary blood flow. We sought to compare the diagnostic value of echocardiography and CMR for assessing pulmonary vein anatomy after the APA.MethodsThis retrospective study evaluated all consecutive patients between October 1998 and January 2010 after either a primary or secondary APA followed by post-repair CMR.ResultsOf 103 patients who had an APA, 31 patients had an analyzable CMR study. The average time to CMR was 24.6 ± 32.5 months post-repair. Echocardiographic findings were confirmed by CMR in 12 patients. There was incomplete imaging by echocardiography in 7 patients and underestimation of pulmonary vein restenosis in 12, when compared to CMR. In total, 19/31 patients (61%) from our cohort had significant stenosis following the APA as assessed by CMR. Our data suggest that at least 18% (19/103) of all patients had significant obstruction post-repair.ConclusionsEchocardiography incompletely imaged or underestimated the severity of obstruction in patients compared with CMR. Pulmonary vein stenosis remains a sizable complication after repair, even using the APA.

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Technical modifications for improved results in total anomalous pulmonary venous drainage

Cited by 35 publications

References 17 publications

Outcomes of Surgery for Total Anomalous Pulmonary Venous Return without Total Circulatory Arrest

Outcomes of Surgery for Total Anomalous Pulmonary Venous Return without Total Circulatory Arrest

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

Assessment of pulmonary veins after atrio-pericardial anastomosis by cardiovascular magnetic resonance

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