Surgical Results of Mixed-type Total Anomalous Pulmonary Venous Connection: Postoperative Hemodynamics of the Uncorrected Minor Anomalous Pulmonary Vein

Pediatric Cardiology and Cardiac Surgery
Vol.26 No.1 2010 (78-82)

Mitsuhiro Kimura,¹ Yoshihiro Honda,¹ Shunji Uchita,¹ Takako Nishino,¹ Yasuyuki Toyoda,¹ Yorikazu Harada,¹ Gengi Satomi,² Satoshi Yasukouchi,² and Kiyohiro Takigiku²⁾

Departments of ¹⁾Cardiovascular Surgery and ²⁾Cardiology, Nagano Children’s Hospital, Nagano, Japan

Abstract

Background: Surgical strategies for mixed-type total anomalous pulmonary venous connection (TAPVC) are still controversial because of its various patterns of abnormal pulmonary venous (PV) connection.
Purpose: In our institute, the surgical strategy for mixed-type TAPVC is correction of the major anomalous PV connection without correction of the minor anomalous PV. In this study we evaluated the behavior of the residual minor anomalous PV after operation.
Patients and methods: Eight patients with mixed-type TAPVC underwent intracardiac repair. Subtotal correction was performed for 7 patients and total correction for one patient. For evaluation of postoperative hemodynamic changes, cardiac catheterization, ultrasonic echocardiography, and chest X-ray were performed in all patients.
Results: In the early postoperative state, occlusion of a residual PV connection was observed in four cases without any pulmonary congestion or respiratory and hemodynamic disorder. Increased residual PV flow was observed in two cases of major PV orifice stenosis, and correction of the residual PV connection was required in these cases. In one case of total correction, additional abnormal PV drainage was found at the time of postoperative cardiac catheterization. Postoperative right ventricular (RV) pressure and RV end-systolic volume showed 34±4 mmHg and 134±15% of normal, respectively. The postoperative cardiothoracic ratio showed 52±4%.
Conclusion: In subtotal surgical correction of mixed-type TAPVC, major PV orifice stenosis progression may induce the acceleration of residual minor anomalous PV blood flow. Thus, in cases where anastomotic stenosis is observed, residual PV connection should be corrected.