Analysis of risk factors for pulmonary vein obstruction after cardiac-type total anomalous pulmonary venous connection repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Jingwen ^1,2,3 , CHEN Tianyu ^2,3 , QIU Hailong ^2,3 , LIU Xiaobing ^2,3 ,  ZHUANG Jian ^1,2,3

1. School of Medicine South China University of Technology, Guangzhou, 510006, P. R. China;
2. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, P. R. China;
3. Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, P.R. China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@163.com

Keywords：

Cardiac-type total anomalous pulmonary venous connection; post-repair pulmonary; vein obstruction; echocardiography

DOI：

10.7507/1007-4848.202310064

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Objective To analyze risk factors for pulmonary vein obstruction(PVO) after cardiac-type total anomalous pulmonary venous connection (TAPVC) repair. Methods A retrospective analysis of clinical and echocardiography data of 169 patients with cardiac-type TAPVC who underwent surgery at our center from April 2009 to April 2019 was conducted. Kaplan-Meier curves were used to assess the risk of postoperative pulmonary vein obstruction. Logistic regression analysis was used to identify relevant risk factor for postoperative pulmonary vein obstruction. Results The median age at surgery was 89 days, and the median weight at surgery was 4.8 kg. Post-repair pulmonary vein obstruction occurred in 8.9% (15/169) of cases. The subtype of coronary sinus/right atrium did not significantly affect the risk of PPVO (P=0.33). Relevant risk factors included preoperative pulmonary vein obstruction (P<0.001) and the ratio of left ventricular end-diastolic diameter to right ventricular diameter (P=0.025). Conclusion Surgical repair of cardiac-type TAPVC has achieved satisfactory results in our center, but the long-term risk of obstruction should not be underestimated. An increased ratio of left ventricular end-diastolic diameter to right ventricular diameter and preoperative pulmonary vein obstruction were associated with post-repair pulmonary vein obstruction.

1.	Michielon G, Di Donato RM, Pasquini L, et al. Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur J Cardio-thorac Surg, 2002, 22(2): 184-191.
2.	Shi G, Zhu Z, Chen J, et al. Total anomalous pulmonary venous connection: The current management strategies in a pediatric cohort of 768 patients. Circulation, 2017, 135(1): 48-58.
3.	Kanter KR. Surgical repair of total anomalous pulmonary venous connection. Seminars in thoracic and cardiovascular surgery. Pediatr Card Surg Annu, 2006: 40-44.
4.	White BR, Ho DY, Faerber JA, et al. Repair of total anomalous pulmonary venous connection: risk factors for postoperative obstruction. Ann Thorac Surg, 2019, 108(1): 122-129.
5.	Files MD, Morray B. Total anomalous pulmonary venous connection: Preoperative anatomy, physiology, imaging, and interventional management of postoperative pulmonary venous obstruction. Semin Cardiothorac Vasc Anesth, 2017, 21(2): 123-131.
6.	Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
7.	Seale AN, Uemura H, Webber SA, et al. Total anomalous pulmonary venous connection: morphology and outcome from an international population-based study. Circulation, 2010, 122(25): 2718-2726.
8.	Whight CM, Barratt-Boyes BG, Calder AL, et al. Total anomalous pulmonary venous connection. Long-term results following repair in infancy. J Thorac Cardiovasc Surg, 1978, 75: 52-63.
9.	Delisle G, Ando M, Calder AL, et al. Total anomalous pulmonary venous connection: Report of 93 autopsied cases with emphasis on diagnostic and surgical considerations. Am Heart J, 1976, 91(1): 99-122.
10.	Hörer J, Neuray C, Vogt M, et al. What to expect after repair of total anomalous pulmonary venous connection: data from 193 patients and 2902 patient years. Eur J Cardio-thorac Surg, 2013, 44(5): 800-807.
11.	Husain SA, Maldonado E, Rasch D, et al. Total anomalous pulmonary venous connection: factors associated with mortality and recurrent pulmonary venous obstruction. Ann Thorac Sur, 2012, 94(3): 825-832.
12.	Ando M, Takahashi Y, Kikuchi T. Total anomalous pulmonary venous connection with dysmorphic pulmonary vein: A risk for postoperative pulmonary venous obstruction. Inter Cardiovasc Thorac Surg, 2004, 3(4): 557-561.
13.	Shi G, Zhu F, Wen C, et al. Cardiac-type total anomalous pulmonary venous return is not benign. J Thorac Cardiovasc Surg, 2023, 165(2): 449-459.
14.	Jonas RA, Smolinsky A, Mayer JE, et al. Obstructed pulmonary venous drainage with total anomalous pulmonary venous connection to the coronary sinus. Am J Cardiol, 1987, 59(5): 431-435.
15.	Sakamoto T, Nagashima M, Umezu K, et al. Long-term outcomes of total correction for isolated total anomalous pulmonary venous connection: Lessons from 50-years' experience. Inter Cardiovasc Thorac Surg, 2018, 27(1): 20-26.
16.	Nakazawa M, Jarmakani JM, Gyepes MT, et al. Pre and postoperative ventricular function in infants and children with right ventricular volume overload. Circulation, 1977, 55(3): 479-484.
17.	Valsangiacomo ER, Hornberger LK, Barrea C, et al. Partial and total anomalous pulmonary venous connection in the fetus: Two-dimensional and Doppler echocardiographic findings. Ultrasound Obstet Gynecol, 2003, 22(3): 257-263.
18.	Goor DA, Yellin A, Frand M, et al. The operative problem of small left atrium in total anomalous pulmonary venous connection: report of 5 patients. Ann Thorac Surg, 1976, 22: 245-248.
19.	Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: Risk factors for adverse outcome. Eur J Cardio-thorac Surg, 2003, 24(1): 28-36.
20.	Jenkins KJ, Sanders SP, Orav EJ, et al. Individual pulmonary vein size and survival in infants with totally anomalous pulmonary venous connection. J Am Coll Cardiol, 1993, 22(1): 201-206.
21.	Turley K, Tucker WY, Ullyot DJ, et al. Total anomalous pulmonary venous connection in infancy: influence of age and type of lesion. Am J Cardiol, 1980, 45(1): 92-97.
22.	Haworth SG. Total anomalous pulmonary venous return. Prenatal damage to pulmonary vascular bed and extrapulmonary veins. Br Heart J, 1982, 48(6): 513-524.
23.	Wilson WRJ, Ilbawi MN, DeLeon SY, et al. Technical modifications for improved results in total anomalous pulmonary venous drainage. J Thorac Cardiovasc Surg, 1992, 103(5): 861-871.

1. Michielon G, Di Donato RM, Pasquini L, et al. Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur J Cardio-thorac Surg, 2002, 22(2): 184-191.
2. Shi G, Zhu Z, Chen J, et al. Total anomalous pulmonary venous connection: The current management strategies in a pediatric cohort of 768 patients. Circulation, 2017, 135(1): 48-58.
3. Kanter KR. Surgical repair of total anomalous pulmonary venous connection. Seminars in thoracic and cardiovascular surgery. Pediatr Card Surg Annu, 2006: 40-44.
4. White BR, Ho DY, Faerber JA, et al. Repair of total anomalous pulmonary venous connection: risk factors for postoperative obstruction. Ann Thorac Surg, 2019, 108(1): 122-129.
5. Files MD, Morray B. Total anomalous pulmonary venous connection: Preoperative anatomy, physiology, imaging, and interventional management of postoperative pulmonary venous obstruction. Semin Cardiothorac Vasc Anesth, 2017, 21(2): 123-131.
6. Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
7. Seale AN, Uemura H, Webber SA, et al. Total anomalous pulmonary venous connection: morphology and outcome from an international population-based study. Circulation, 2010, 122(25): 2718-2726.
8. Whight CM, Barratt-Boyes BG, Calder AL, et al. Total anomalous pulmonary venous connection. Long-term results following repair in infancy. J Thorac Cardiovasc Surg, 1978, 75: 52-63.
9. Delisle G, Ando M, Calder AL, et al. Total anomalous pulmonary venous connection: Report of 93 autopsied cases with emphasis on diagnostic and surgical considerations. Am Heart J, 1976, 91(1): 99-122.
10. Hörer J, Neuray C, Vogt M, et al. What to expect after repair of total anomalous pulmonary venous connection: data from 193 patients and 2902 patient years. Eur J Cardio-thorac Surg, 2013, 44(5): 800-807.
11. Husain SA, Maldonado E, Rasch D, et al. Total anomalous pulmonary venous connection: factors associated with mortality and recurrent pulmonary venous obstruction. Ann Thorac Sur, 2012, 94(3): 825-832.
12. Ando M, Takahashi Y, Kikuchi T. Total anomalous pulmonary venous connection with dysmorphic pulmonary vein: A risk for postoperative pulmonary venous obstruction. Inter Cardiovasc Thorac Surg, 2004, 3(4): 557-561.
13. Shi G, Zhu F, Wen C, et al. Cardiac-type total anomalous pulmonary venous return is not benign. J Thorac Cardiovasc Surg, 2023, 165(2): 449-459.
14. Jonas RA, Smolinsky A, Mayer JE, et al. Obstructed pulmonary venous drainage with total anomalous pulmonary venous connection to the coronary sinus. Am J Cardiol, 1987, 59(5): 431-435.
15. Sakamoto T, Nagashima M, Umezu K, et al. Long-term outcomes of total correction for isolated total anomalous pulmonary venous connection: Lessons from 50-years' experience. Inter Cardiovasc Thorac Surg, 2018, 27(1): 20-26.
16. Nakazawa M, Jarmakani JM, Gyepes MT, et al. Pre and postoperative ventricular function in infants and children with right ventricular volume overload. Circulation, 1977, 55(3): 479-484.
17. Valsangiacomo ER, Hornberger LK, Barrea C, et al. Partial and total anomalous pulmonary venous connection in the fetus: Two-dimensional and Doppler echocardiographic findings. Ultrasound Obstet Gynecol, 2003, 22(3): 257-263.
18. Goor DA, Yellin A, Frand M, et al. The operative problem of small left atrium in total anomalous pulmonary venous connection: report of 5 patients. Ann Thorac Surg, 1976, 22: 245-248.
19. Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: Risk factors for adverse outcome. Eur J Cardio-thorac Surg, 2003, 24(1): 28-36.
20. Jenkins KJ, Sanders SP, Orav EJ, et al. Individual pulmonary vein size and survival in infants with totally anomalous pulmonary venous connection. J Am Coll Cardiol, 1993, 22(1): 201-206.
21. Turley K, Tucker WY, Ullyot DJ, et al. Total anomalous pulmonary venous connection in infancy: influence of age and type of lesion. Am J Cardiol, 1980, 45(1): 92-97.
22. Haworth SG. Total anomalous pulmonary venous return. Prenatal damage to pulmonary vascular bed and extrapulmonary veins. Br Heart J, 1982, 48(6): 513-524.
23. Wilson WRJ, Ilbawi MN, DeLeon SY, et al. Technical modifications for improved results in total anomalous pulmonary venous drainage. J Thorac Cardiovasc Surg, 1992, 103(5): 861-871.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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