Browse > Article

Postoperative Pulmonary Vein Stenosis (PVS) in Patients with TAPVR  

Jung Sung-Ho (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Park Jeong-Jun (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Yun Tae-Jin (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Jhang Won-Kyoung (Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine)
Kim Young-Hwue (Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine)
Ko Jae-Kon (Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine)
Park In-Sook (Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine)
Seo Dong-Man (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Publication Information
Journal of Chest Surgery / v.39, no.5, 2006 , pp. 347-353 More about this Journal
Abstract
Background: Despite recent advances in surgical technique and perioperative care of total anomalous pulmonary venous return (TAPVR), post-repair pulmonary vein stenosis (PVS) remains as a serious complication. We thought that the most important factors of TAPVR repair to prevent PVS were good exposure, proper alignment, and sufficient stoma size. We analyzed our experience retrospectively. Material and Method: Between Jan. 1995 and Feb. 2005, we studied 74 patients diagnosed with TAPVR suitable for biventricular repair. Supra-cardiac type (n=41, 55.4%) was the most common. Mean CPB time, ACC time, and TCA (40.5%, 30/74) time were $92.1{\pm}25.9\;min,\;39.1{\pm}10.6\;min$, and $30.2{\pm}10.7\;min$, respectively. Mean follow-up duration was $41.4{\pm}29.1$ months and follow-up was possible in all patients. Result: The median age and body weight at operation were 28.5 days ($0{\sim}478$ days) and 3.4 kg $(1.4{\sim}9\;kg)$. Early mortality was 4.1% (3/74). Causes of death were pulmonary hypertensive crisis, sepsis, and sudden death. There was PR-PVS in 2 patients (early: 1, late: 1). Both patients were cardiac type TAPVR drained to coronary sinus. Re-operations were done but only one patient survived. Cumulative survival rate in 5 year and percent freedom from PVS were $94.5{\pm}2.7%\;and\;97.2{\pm}2.0%$, respectively. Conclusion: There was no PVS in patients who underwent extra-cardiac anatomosis between LA and CPVC. Therefore it could be said that our principle might be effective in preventing PR-PVS in patients suitable two-ventricle.
Keywords
Pulmonary vein; total anomalous return; Pulmonary vein stenosis;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Sano S, Brawn WJ, Mee RBB. Total anomalous pulmonary venous drainage. J Thorac Cardivasc Surg 1989;97:886-92
2 Van de Wal HJCM, Hamilton DI, Godman MJ, Harinck E, Lacquet LK, van Oort A. Pulmonary venous obstruction following correction for total anomalous pulmonary venous drainage: a challenge. Eur J Cardiothoracic Surg 1992;6:545-9   DOI   ScienceOn
3 Tucker BL, Lindesmith GG, Stiles QR, Meyer BW. The superior approach for correction of the supracardiac type of total anomalous pulmonary venous return. Ann Thorac Surg 1976;22:374-7   DOI   ScienceOn
4 Hancock Friesen CL, Zurakowski D, Thiagarajan RR, et al. Total anomalous pulmonary venous connection: an analysis of current management strategies in a single institution. Ann Thorac Surg 2005;79:596-606   DOI   ScienceOn
5 Jonas RA, Smolinsky A, Mayer JE, Castaneda AR. Obstructed pulmonary venous drainage with total anomalous pulmonary venous connection to the coronary sinus. Am J Cardiol 1987;59:431-5   DOI   ScienceOn
6 Najm HK, Caldarone CA, Smallhorn J, Coles JG. A sutureless technique for the relief of pulmonary vein stenosis with the use of in situ pericardium. J Thorac Cardiovasc Surg 1998;115:468-70   DOI   ScienceOn
7 Sellke FW, del Nido PJ, Swanson SJ. Sabiston & Spencer surgery of the chest. 7th ed. Philadelphia: Elsevier. 2005;1949-61
8 Song JY, Yoon YS. Long-term clinical study of total anomalous pulmonary venous return. J Korean Pediatr Soc 2000; 43:229-35
9 Caldarone CA, Najm HK, Kadletz M, et al. Relentless pulmonary vein stenosis after repair of total anomalous ulmonary venous drainage. Ann Thorac Surg 1998;66:1514-20   DOI   ScienceOn
10 Bando K, Turrentine MW, Ensing GJ, et al. Surgical management of total anomalous pulmonary venous connection. Thirty-year trends. Circulation 1996;94(9 Suppl):II12-6
11 Lacour-Gayet F, Zofhbi J, Serraf AE, et al. Surgical management of progressive pulmonary venous obstruction after repair of total anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 1999;117:679-87   DOI   ScienceOn
12 Serraf A, Belli E, Roux D, Sousa-Uva M, Lacour-Gayet F, Planche C. Modified superior approach for repair of supracardiac and mixed total anomalous pulmonary venous drainage. Ann Thorac Surg 1998;65:1391-3   DOI   ScienceOn
13 Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Cardiac surgery. 3rd ed. New York: Churchill Livingstone. 2003;753-79
14 Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: risk factors for adverse outcome. Eur J Cardiothorac Surg 2003; 24:28-36; discussion 36   DOI   ScienceOn
15 Yun TJ, Coles JG, Konstantinov IE, et al. Conventional and sutureless techniques for management of the pulmonary veins: evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies. J Thorac Cardiovasc Surg 2005;129:167-74   DOI   ScienceOn
16 Keith JD, Rowe RD, Vlad P, O'Hanley JH. Complete anomalous pulmonary venous drainage. Am J Med 1954;16:23   DOI   ScienceOn
17 Sung SC, Bang JH, Jun HJ, et al. Surgical correction of total anomalous pulmonary venous connection in early infancy. Korean J Thorac Cardiovasc Surg 1999;32:510-7
18 Wilson WR, Ilbawi MN, DeLeon SY, et al. Technical modifications for improved results in total anomalous pulmonary venous drainage. J Thorac Cardiovasc Surg 1992;103: 861-71
19 Hong YS, Park YH, Lim SH, Cho BK, Rho HK. Repair of total anomalous pulmonary venous return in infant. Korean J Thorac Cardiovasc Surg 1999;32:1004-8
20 Hyde JA, Stumper O, Barth MJ, et al. Total anomalous pulmonary venous connection: outcome of surgical correction and management of recurrent venous obstruction. Eur J Cardiothorac Surg 1999;15:735-40   DOI   ScienceOn