ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2020, 5(2): 91–96
https://doi.org/10.26693/jmbs05.02.091
Clinical Medicine

Analysis of the Results of Surgical Treatment of TAPVD

Imanov E. 1, Truba Ya. P. 1, Plyska O. I. 2, Sloboda A. O. 1, Lazoryshynets V. V. 1
Abstract

The purpose of the study was to analyze the results of surgical treatment of total abnormal pulmonary vein drainage at the National Academy of Cardiovascular Surgery of the National Academy of Medical Sciences for the period from 2007 to 2019. Material and methods. During this period 34 patients were operated at the National Amosov Institute of Cardiovascular Surgery, 15 female (44.1%) and 19 male (55.8%). One man was operated twice. The criterion for selection for critical defect was the total abnormal drainage of the pulmonary veins, requiring emergency surgical treatment. On the whole, 36 operations were performed. On the day of surgery, the average age of the patients was 109.3 ± 101.4 days (from 2 to 505 days), and their average weight was 4.01 ± 1.1 kg. 17 patients had the defect diagnosed prenatally and confirmed by Echo-KG immediately after birth. In 10 cases it was diagnosed at birth, which allowed the immediate delivery to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences for the provision of highly qualified medical care. It should be noted that 31 patients had an accurate anatomical diagnosis based on Echocardiography alone. This helped avoid angiocardiography, which had a significant negative impact on the condition of patients in the preoperative period. It was found that in 14.2% (5) patients there was a supracardial form of anomaly, in 57.1% (20) it was an intracardiac form, in 17.1% (6) patients it was infracardial and 11.4% (4) had a mixed form. Echocardiography revealed that 100% of pulmonary hypertension was observed in 57.1% (20) of cases. Results and discussion. . In all cases, surgery was performed to radically correct the total abnormal drainage of the pulmonary veins. In addition, in 4 cases, such a surgery was supplemented by the Rashkind procedure. After surgery, 32 out of 34 patients (94.1%) were discharged to inpatient hospitals for continuing treatment. Thus, the mortality rate was 5.9%. In one case of repeated operative intervention after 6 months, a total anomalous drainage of the pulmonary veins was performed, and after 2 months – RKTAPVD. After repeated surgical interventions, the patient experienced improvement, and he was discharged from the clinic in satisfactory condition. During surgery, the following complications were observed: hemolysis – 1 case, pulmonary edema – 1 case, pneumothorax – 1 case, perforation of the subclavian artery – 1 case, paresis of the left dome of the diaphragm – 1 case, acute heart failure – 4 cases which transferred into the postoperative complications. They were: acute ventricular failure, acute heart failure – 3 cases, respiratory failure – 1 case, small ejection syndrome with renal failure – 1 case, pneumothorax – 1 case, hemolysis – 1 case, atelectasis left th lung – supraventricular tachycardia – 2 cases, atrial flutter – 1 case. Later they became the cause of fatal cases – in the postoperative period 2 (5.9%) patients died. The causes of death among patients were: progressive heart failure (n=1), which was a consequence of small size of the left ventricle; pulmonary hypertensive crises (n=1), due to increased reactivity of the pulmonary vascular bed in the early postoperative period. There was also a respiratory failure – 1 case; perforation of the left atrium during the Rashkind procedure – 1 case; surgical bleeding – 1; supraventricular tachycardia with development of arrhythmogenic shock – 1, acute heart failure – 3 cases (among them there was 1 left ventricular failure due to myocardial infarction, 1 right ventricular failure due to thrombosis of the pulmonary artery, 1 lower thoracic artery). Thus, the results coincided with similar ones in other studies. Conclusion. Despite the high lethality, such surgical interventions should be performed, as this is the only chance to save these patients and prolong their life, and to prepare them for the next surgery. It should also be noted that the fatality rate is constantly decreasing.

Keywords: radical correction, pulmonary veins, restenosis, total abnormal drainage

Full text: PDF (Ukr) 210K

References
  1. Michielon G, Di Donato RM, Pasquini L, Giannico S, Brancaccio G, Mazzera E, et al. Total anomalous pulmonary venous connection: long term appraisal with evolving technical soluti? Ons Eur J Cardiothorac Surg. 2002; 22: 184-91. PMID: 12142183. https://doi.org/10.1016/s1010-7940(02)00247-6
  2. Seale AN, Uemura H, Webber SA, Partridge J, Roughton M, Ho SY, et al. Total Anomalous Pulmonary Venous Connection. Morphology and Outcome From an International Population-Based Study. Circulation. 2010; 122: 2718- 26. PMID: 21135364. https://doi.org/10.1161/CIRCULATIONAHA.110.940825
  3. Noori NM, Meraji M, Motamedi MH, et al. Surgical Outcome for Correction of Total Anomalous Pulmonary Venous Connection in Children. Iranian Heart Journal. 2001; 2(2): 15-8.
  4. Jian XH, Huang J, Ding Y, Xiao XJ, Wu M, Chen JM, et al. Surgical Outcome of Isolated Total Anomalous Pulmonary Venous Connection in Adults: A 14-Year Experience. J Card Surg. 2012; 27(6): 736-9. PMID: 23046109. https://doi.org/10.1111/jocs.12006
  5. Modi A, Vohra HA, Brown I, Langley SM. Successful surgical correction of total anomalous pulmonary venous drainage in the sixth decade. Ann Thorac Surg. 2008; 86(5): 1684-6. PMID: 19049779. https://doi.org/10.1016/j.athoracsur.2008.04.091
  6. Ogawa M, Nakagawa M, Hara M, Ito M, Goto T, Ohte N, et al. Total Anomalous Pulmonary Venous Connection in a 64-Year-Old Man: A Case Report. Ann Thorac Cardiovasc Surg. 2013; 19: 46-8. PMID: 23485632. https://doi.org/10.5761/atcs.cr.11.01763
  7. Shin DH, Park HE, Choi SI, Park KH, Choi JY, Cho GY. Atrial Septal Defect With Total Anomalous Pulmonary Venous Return in an Adult. Circulation. 2011; 123: e612-3. PMID: 21632513. https://doi.org/10.1161/CIRCULATIONAHA.110.986752
  8. Wu FM, Emani SM, Landzberg MJ, Valente AM. Rare case of undiagnosed supracardiac total anomalous pulmonary venous return in an adult. Circulation. 2014; 130(14): 1205-7. PMID: 25266862. https://doi.org/10.1161/CIRCULATIONAHA.114.008013
  9. Abdel Razek AAK, Al-Marsafawy H, Elmansy M, El-Latif MA, Sobh D. Computed Tomography Angiography and Magnetic Resonance Angiography of Congenital Anomalies of Pulmonary Veins. J Comput Assist Tomogr. 2019 May/Jun; 43(3): 399-405. PMID: 31082945. https://doi.org/10.1097/RCT.0000000000000857
  10. Pandey NN, Sharma A, Jagia P. Imaging of anomalous pulmonary venous connections by multidetector CT angiography using third-generation dual source CT scanner. Br J Radiol. 2018: Dec; 91(1092): 357-65. PMID: 30004806. PMCID: PMC6319858. https://doi.org/10.1259/bjr.20180298
  11. Rashkind WJ, Miller WW. Creation of an atrial septal defect without thoracotomy: palliative approach to complete transposition of the great arteries. JAMA.1966; 196: 991-2. PMID: 4160716
  12. Yemets IM. Totalnyy anomalnyy drenazh legenevykh ven: rezultaty khirurgichnogo likuvannya [Total anomalous drainage of the pulmonary veins: results of surgical treatment]. Khirurgiya dytyachogo viku. 2012; 3: 19-24. [Ukrainian]
  13. Abdulaev FZ, Bagyrov YM, Kazymadze ND, y dr. Korrektsyya totalnogo anomalnogo drenazha legochnykh ven u vzroslykh bolnykh [Correction of total abnormal pulmonary vein drainage in adult patients]. Kardyologyya y serdechno-sosudystaya khyrurgyya. 2015; 6: 74-9.
  14. Lee Y, Cho JY, Kwon OY, Jang WS. Outcomes of Surgery for Total Anomalous Pulmonary Venous Return without Total Circulatory Arrest. Korean J Thorac Cardiovasc Surg. 2016; 49: 337-43. https://doi.org/10.5090/kjtcs.2016.49.5.337
  15. Korbmacher B, Büttgen S, Schulte HD, Hoffmann M, Krogmann ON, Rammos S, et al. Long-term results after repair of total anomalous pulmonary venous connection. Thorac Cardiovasc Surgeon. 2001; 49(2): 101-6. PMID: 11339445. https://doi.org/10.1055/s-2001-11706
  16. Seale AN, Uemura H, Webber SA, Partridge J, Roughton M, Ho SY, et al. Total Anomalous Pulmonary Venous Connection. Morphology and Outcome From an International Population-Based Study. Circulation. 2010; 122: 2718-26. PMID: 21135364. https://doi.org/10.1161/CIRCULATIONAHA.110.940825
  17. Fu CM, Wang JK, Lu CW, Chiu SN, Lin MT, Chen CA, et al. Total Anomalous Pulmonary Venous Connection: 15 Years’ Experience of a Tertiary Care Center in Taiwan. Pediatrics and Neonatology. 2012; 53: 164-70. PMID: 22770104. https://doi.org/10.1016/j.pedneo.2012.04.002
  18. Kanter KR. Surgical Repair of Total Anomalous Pulmonary Venous Connection. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann. 2006; 9: 40-4. PMID: 16638546. https://doi.org/10.1053/j.pcsu.2006.02.015
  19. Kirklin JW, Barratt-Boyes BG. Total anomalous pulmonary venous connection. In: Kirklin JW, Barratt-Boyes BG, Eds. Cardiac Surgery. Fourth Edition. Saunders; 2013. p. 1182-208.
  20. Shi G, Zhu Z, Chen J, Ou Y, Hong H, Nie Z, et al. Total Anomalous Pulmonary Venous Connection, the current management strategies in a pediatric cohort of 768 patients. Circulation. 2017; 135: 48–58. PMID: 27881562. https://doi.org/10.1161/CIRCULATIONAHA.116.023889
  21. Tarui T, Watanabe G, Kiuchi R, Tomita S, Ohtake H, Yoshizumi K. Surgical Repair for the Treatment of Pulmonary Vein Stenosis After Radiofrequency Ablation. Ann Thorac Surg. 2017: 104(3): e253–e254. PMID: 28838520. https://doi.org/10.1016/j.athoracsur.2017.03.071
  22. Craig JM, Darling RC, Rothney WB. Total pulmonary venous drainage into the right side of the heart; report of 17 autopsied cases not associated with other major cardiovascular anomalies. Lab Invest. 1957; 6(1): 44-64. PMID: 13386206
  23. Karamlou T, Gurofsky R, Al Sukhni E, Coles JG, Williams WG, Caldarone CA, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circiulation. 2007; 115(12): 1591-8. PMID: 17353446. https://doi.org/10.1161/CIRCULATIONAHA.106.635441
  24. Ley S, Lay-Zaporozhan J. Congenital heart diseasesin adalt. Imagion anddiagnosis. Springer; 2016. p. 49.