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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2011 August;24(4):191-6
Urgent surgical correction of infracardiac total anomalous pulmonary venous connection in neonates
Yong A., Chun W., Zheng-Xia P., Gang W., Yong-Gang L., Hong-Bo L., Jiang-Tao D.
Department of Cardiovascular and Thoracic Surgery, Chongqing Children’s Hospital, Chongqing Medical University, Chongqing, China
Aim. The natural history of infracardiac total pulmonary venous connection (TAPVC) is unfavorable per se. Obstruction of the pulmonary venous pathway is a powerful predictor of adverse natural outcome and the tendency for pulmonary venous obstruction. Althorugh surgical outcome of infracardiac TAPVC has improved, postoperative pulmonary venous obstruction is still associated with reoperation or death. We reviewed our experience of surgical correction of infracardiac TAPVC in neonates.
Methods. Immediate surgical correction in four neonates with infracardiac total pulmonary venous connection using inner-atrial anastomosis was reviewed.
Results. All patients presented early and often unwell with cyanosis and obstruction to the pulmonary venous pathway. Three of them in whom descending vein connected to the portal vein were operated on immediately with excellent results, including one patient combined with tetrology of Fallot. One patient in whom the descending vein connected to the ductus venous with bad condition was operated on rapidly with successful outcome. The further postoperative courses of all patients were uneventful. No recurrent pulmonary venous obstruction was founded in follow-up study at 18, 16, 13 and 12 months after surgery, respectively.
Conclusion. Multi-detector row computed tomography is a useful technique to confirm the diagnosis of infracardiac TAPVC. Operation should be performed on an emergency basis when the descending vein connects to portal vein or the ductus venous. Inner-atrial anastomosis provides excellent results for primary repair of infracardiac TAPVC in neonates.