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Total anomalous pulmonary venous connection: Outcome of postoperative pulmonary venous obstruction

Seale, Anna N. ; Uemura, Hideki ; Webber, Steven A. ; Partridge, John ; Roughton, Michael ; Ho, Siew Y. ; McCarthy, Karen P. ; Jones, Sheila ; Shaughnessy, Lynda and Sunnegardh, Jan , et al. (2013) In Journal of Thoracic and Cardiovascular Surgery 145(5). p.1255-1262
Abstract
Objective: Pulmonary venous obstruction (PVO) is an important cause of late mortality in total anomalous pulmonary venous connection (TAPVC). We aimed to describe current practices for the management of postoperative PVO and the efficacy of the different interventional procedures. Methods: We conducted a retrospective international collaborative population-based study involving 19 pediatric cardiac centers in the United Kingdom, Ireland, and Sweden. Patients with TAPVC born between January 1, 1998, and December 31, 2004, were identified. Patients with functionally univentricular circulation or atrial isomerism were excluded. All available data and images were reviewed. Results: Of 406 patients undergoing repair of TAPVC, 71 (17.5%) had... (More)
Objective: Pulmonary venous obstruction (PVO) is an important cause of late mortality in total anomalous pulmonary venous connection (TAPVC). We aimed to describe current practices for the management of postoperative PVO and the efficacy of the different interventional procedures. Methods: We conducted a retrospective international collaborative population-based study involving 19 pediatric cardiac centers in the United Kingdom, Ireland, and Sweden. Patients with TAPVC born between January 1, 1998, and December 31, 2004, were identified. Patients with functionally univentricular circulation or atrial isomerism were excluded. All available data and images were reviewed. Results: Of 406 patients undergoing repair of TAPVC, 71 (17.5%) had postoperative PVO. The diagnosis was made within 6 months of surgery in 59 (83%) of the 71 patients. In 12, serial imaging documented change in appearance of the pulmonary veins. Good-sized pulmonary veins can progress to diffusely small veins and rarely atresia. Patients presenting after 6 months had less severe disease; all are alive at most recent follow-up. Fifty-six (13.8%) of 406 patients underwent intervention for postoperative PVO: 44 had surgical treatment and 12 had an initial catheter intervention. One half underwent 1 or more reinterventions. Three-year survival for patients with postoperative PVO was 58.7%(95% confidence intervals, 46.2%-69.2%) with a trend that those having a surgical strategy did better (P = .083). Risk factors for death included earlier presentation after TAPVC repair, diffusely small pulmonary veins at presentation of postoperative PVO, and an increased number of lung segments affected by obstruction. Conclusions: Postoperative PVO tends to appear in the first 6 months after TAPVC repair and can be progressive. Early intervention for PVO may be indicated before irreversible secondary changes occur. (J Thorac Cardiovasc Surg 2013;145:1255-62) (Less)
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Journal of Thoracic and Cardiovascular Surgery
volume
145
issue
5
pages
1255 - 1262
publisher
Mosby
external identifiers
  • wos:000317840600019
  • scopus:84876415138
  • pmid:22892140
ISSN
1097-685X
DOI
10.1016/j.jtcvs.2012.06.031
language
English
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yes
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4cd181bc-499e-4695-a699-a71883592353 (old id 3853644)
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2016-04-01 14:25:56
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2020-01-19 04:36:03
@article{4cd181bc-499e-4695-a699-a71883592353,
  abstract     = {Objective: Pulmonary venous obstruction (PVO) is an important cause of late mortality in total anomalous pulmonary venous connection (TAPVC). We aimed to describe current practices for the management of postoperative PVO and the efficacy of the different interventional procedures. Methods: We conducted a retrospective international collaborative population-based study involving 19 pediatric cardiac centers in the United Kingdom, Ireland, and Sweden. Patients with TAPVC born between January 1, 1998, and December 31, 2004, were identified. Patients with functionally univentricular circulation or atrial isomerism were excluded. All available data and images were reviewed. Results: Of 406 patients undergoing repair of TAPVC, 71 (17.5%) had postoperative PVO. The diagnosis was made within 6 months of surgery in 59 (83%) of the 71 patients. In 12, serial imaging documented change in appearance of the pulmonary veins. Good-sized pulmonary veins can progress to diffusely small veins and rarely atresia. Patients presenting after 6 months had less severe disease; all are alive at most recent follow-up. Fifty-six (13.8%) of 406 patients underwent intervention for postoperative PVO: 44 had surgical treatment and 12 had an initial catheter intervention. One half underwent 1 or more reinterventions. Three-year survival for patients with postoperative PVO was 58.7%(95% confidence intervals, 46.2%-69.2%) with a trend that those having a surgical strategy did better (P = .083). Risk factors for death included earlier presentation after TAPVC repair, diffusely small pulmonary veins at presentation of postoperative PVO, and an increased number of lung segments affected by obstruction. Conclusions: Postoperative PVO tends to appear in the first 6 months after TAPVC repair and can be progressive. Early intervention for PVO may be indicated before irreversible secondary changes occur. (J Thorac Cardiovasc Surg 2013;145:1255-62)},
  author       = {Seale, Anna N. and Uemura, Hideki and Webber, Steven A. and Partridge, John and Roughton, Michael and Ho, Siew Y. and McCarthy, Karen P. and Jones, Sheila and Shaughnessy, Lynda and Sunnegardh, Jan and Hanséus, Katarina and Berggren, Hakan and Johansson, Sune and Rigby, Michael L. and Keeton, Barry R. and Daubeney, Piers E. F.},
  issn         = {1097-685X},
  language     = {eng},
  number       = {5},
  pages        = {1255--1262},
  publisher    = {Mosby},
  series       = {Journal of Thoracic and Cardiovascular Surgery},
  title        = {Total anomalous pulmonary venous connection: Outcome of postoperative pulmonary venous obstruction},
  url          = {http://dx.doi.org/10.1016/j.jtcvs.2012.06.031},
  doi          = {10.1016/j.jtcvs.2012.06.031},
  volume       = {145},
  year         = {2013},
}