Korean J Thorac Cardiovasc Surg.  1999 Jun;32(6):510-517.

Surgical Correction of Total Anomalous Pulmonary Venous Connection in Early Infancy

• Sung SC
• Bang JH
• Jun HJ
• Jo KJ
• Choi PJ
• Woo CS
• Lee IG
• Lee HD

Abstract

BACKGROUND: Total anomalous pulmonary venous connection (TAPVC) is still one of the more challenging congenital heart defects in newborns and young infants. The purpose of the study is to evaluate the early and midterm results of the surgical corrections for patients in early infancy with isolated TAPVC. MATERIAL AND METHOD: Hospital records of 15 consecutive patients in early infancy (January 1993 to August 1998) were retrospectively reviewed. There were 8 boys and 7 girls whose ages ranged from 4 days to 3.5 months (median age 22 days). Their body weight ranged from 1.75 kg to 4.9 kg (mean 3.54 kg). The abnormal anatomical connections were supracardiac in 11, cardiac in 3, and infracardiac in 1. In 6 patients (40%), the pulmonary venous drainage was obstructive. Total circulatory arrest was used in 13 patients. Anastomosis between the common pulmonary vein and the left atrium was performed with a continuous suture technique using a fine nonabsorbable polypropylene suture through a lateral approach behind the right atrium. RESULT: There was one hospital death (6.5%) caused by a sepsis 17 days after the operation in a neonate who had supracardiac drainage and was dependent on a ventilator preoperatively. There were 2 late deaths. One died sudde`nly of an unknown cause at home 2.5 years after the operation and the other died of a recurrent pulmonary hypertension 3 months after the reoperation due to pulmonary venous obstruction (PVO). Two patients required reoperations because of PVO 5 months and 10 months respectively after the initial operation. Of these patients, one patient is alive at the present time with persistent pulmonary hypertension. All survivors without postoperative PVO (78.6%) were in NYHA functional class I at mean follow-up of 25.8 months (0.5~67 months).
CONCLUSION
Surgical correction of TAPVC in early infancy can be performed at low risk. However, there were 2 postoperative PVOs (14.3%) which had bad results. The survivors without postoperative PVO had excellent functional status.

Keyword

Pulmmary vein, total anomolous return

MeSH Terms

Body Weight
Drainage
Female
Follow-Up Studies
Heart Atria
Heart Defects, Congenital
Hospital Records
Humans
Hypertension, Pulmonary
Infant
Infant, Newborn
Polypropylenes
Pulmonary Veins
Reoperation
Retrospective Studies
Sepsis
Survivors
Suture Techniques
Sutures
Ventilators, Mechanical
Polypropylenes