Early-term surgical outcomes after correction of total anomalous pulmonary venous connection

Highlights. The geometry of the left atrium and the growth of the left heart after correction of total anomalous pulmonary venous connection are evaluated for the first time.

Aim. To assess the morphological and functional characteristics of the left heart after correction of total anomalous pulmonary venous connection.

Methods. 40 patients referred to the correction of total anomalous pulmonary venous connection were enrolled in a pilot, two-center, simple, blind, prospective randomized study. Patients were assigned to the sutureless repair group (n = 20) and conventional repair group (n = 20).

Results. In the early postoperative period, the indexed left atrial volume in the group of sutureless repair was 15 (13.65; 17.25) versus 12.85 (10.95; 15.15) in the group of conventional repair, p = 0.057. The end diastolic volume index in the sutureless repair group was 38 (28.5; 45), while in the conventional repair group - 37.1 (31; 47.75), p = 0.48. At the follow-up, the indexed left atrial volume in the group of sutureless repair was 37 (34.5; 38.9) versus 31 (23.6; 35) in the group of conventional repair, p = 0.01. The end diastolic volume index (EDVI) in the group of sutureless repair was 50 (43; 57), while in the group of conventional repair - 50.2 (28.8; 60.9), p = 0.49.

Conclusion. The growth of the left atrium depended on the chosen technique for correcting total anomalous pulmonary venous connection and was higher in the group of sutureless repair (37) compared to the group of conventional repair (31). The proportionality of the growth of the left ventricle did not depend on the surgical technique and was equivalent in both groups.

1. Seale A. N., Uemura H., Webber S. A., Partridge J., Roughton M., Ho S. Y., McCarthy K.P., Jones S., Shaughnessy L., Sunnegardh J., Hanseus K., Berggren H., Johansson S., Rigby M.L., Keeton B.R., Daubeney P.E.; British Congenital Cardiac Association. Total anomalous pulmonary venous connection: outcome of postoperative pulmonary venous obstruction. J. Thorac. Cardiovasc. Surg. 2013;145:1255–1262. doi: 10.1016/j.jtcvs.2012.06.031

2. Hancock Friesen C.L., Zurakowski D., Thiagarajan R.R., Forbes J.M., del Nido P.J., Mayer J.E., Jonas R.A. Total anomalous pulmonary venous connection: an analysis of current management strategies in a single institution. Ann. Thorac. Surg. 2005;79:596-606. doi: 10.1016/j.athoracsur.2004.07.005.

3. Caldarone C.A., Najm H.K., Kadletz M., Freedom R.M., Williams W.G., Coles J.G. Surgical management of total anomalous pulmonary venous drainage: impact of coexisting cardiac anomalies. Ann. Thorac. Surg. 1998;66(5):1521-526. doi: 10.1016/s0003-4975(98)00951-5.

4. Wilson J. A description of a very unusual formation of the human heart. Philosoph. Trans. Roy. Soc. London. 1898; 88: 346.

5. Kelle A.M., Backer C.L., Gossett J.G., Kaushal S., Mavroudis C. Total anomalous pulmonary venous connection: results of surgical repair of 100 patients at a single institution. J. Thorac. Cardiovasc. Surg. 2010. 139:1387-1394 e3. doi: 10.1016/j.jtcvs.2010.02.024.

6. Lacour-Gayet F. Surgery for pulmonary venous obstruction after repair of total anomalous pulmonary venous return. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006;45-50. doi: 10.1053/j.pcsu.2006.02.010.

7. Matsuhisa H, Oshima Y, Maruo A, Hasegawa T, Tanaka A, Noda R. Primary sutureless repair and anterior translocation of the atrial septum for cardiac total anomalous pulmonary venous connection. Ann Thorac Surg. 2013;95:729-730. doi: 10.1016/j.athoracsur.2012.09.080.

8. Yanagawa B., Alghamdi A.A., Dragulescu A., Viola N., Al-Radi O.O., Mertens L.L., Coles J.G., Caldarone C.A., Van Arsdell G.S. Primary sutureless repair for "simple" total anomalous pulmonary venous connection: midterm results in a single institution. J. Thorac. Cardiovasc. Surg. 2011. 141(6):1346-54. doi: 10.1016/j.jtcvs.2010.10.056.

9. Chowdhury U.K., Sankhyan L.K. The vertical vein in patients with obstructive supracardiac totally anomalous pulmonary venous connection: we can ligate it but should we ligate it? Clin Case Reports Int. 2018;2:1066.

10. Mathew R., Thilenius O.G., Replogle R.L., Arcilla R.A. Cardiac function in total anomalous pulmonary venous return before and after surgery. Circulation. 1977;55(2):361-370. doi: 10.1161/01.cir.55.2.361.

11. Lang, R.M., Bierig, M., Devereux, R.B., Flachskampf, F.A., Foster, E., Pellikka, P.A. et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005; 18: 1440-1463. doi: 10.1016/j.echo.2005.10.005.

12. Anderson R.H., Brown N.A., Moorman A.F.M. Development and structures of the venous pole of the heart. Dev. Dyn. 2006; 235:2-9. doi: 10.1002/dvdy.20578.

13. van den Berg G., Moorman A.F. Development of the pulmonary vein and the systemic venous sinus: an interactive 3D overview. PLoS. One. 2011; 6: e22055. doi: 10.1371/journal.pone.0022055.

14. Soynov I.A., Kulyabin Yu.Yu., Nichay N.R., Voitov A.V., Gorbatykh A.V., Ivantsov S.M., Leykekhman A.V., Bogachev-Prokofiyev A.V., Litasova E.E. Invagination of the left atrial appendage in infant after ventricular septal defect closure. Complex Issues of Cardiovascular Diseases. 2016;(3):66-68. (In Russian) https://doi.org/10.17802/2306-1278-2016-3-66-68

15. Alexi-Meskhishvili V., Unbehaun A., Hetzer R. Anomalous Pulmonary Venous Connections and Congenital Defects of the Atria, the Atrioventricular Septum, and the Atrioventricular Valves. In: Ziemer G., Haverich A. (eds) Cardiac Surgery. Berlin. Heidelberg: Springer; 2017

16. Kirshborn P., Jaggers J., Underleider R. Total anomalous pulmonary venous connection. In: Pediatric Cardiac Surgery. 3rd. ed. Mavroudis C (Ed). Philadelphia:Mosby; 2003.

17. Keane J.F., Fyler D.C. Total anomalous pulmonary venous return. In: Nadas' Pediatric Cardiology. 2nd. Keane J.F., Lock J.E., Fyler D.C. (Eds). Philadelphia: Saunders Elsevier; 2006.

18. Behrendt D.M., Aberdeen E., Waterston D.J. Total anomalous pulmonary venous drainage in infants. Circulation. 1972; 46:347-356.

19. Wu Y., Wu Z., Zheng J., Li Y., Zhou Y., Kuang H., Jin X., Wu C. Sutureless technique versus conventional surgery in the primary treatment of total anomalous pulmonary venous connection: a systematic review and meta-analysis. J Cardiothorac Surg. 2018;13(1):69. doi: 10.1186/s13019-018-0756-z.

20. Lucas R.V. Jr., Woolfrey B.F., Anderson R.C., Lester R.G., Edwards J.E. Atresia of the common pulmonary vein. Pediatrics. 1962. 29:729.

21. Honjo O., Atlin C.R., Hamilton B.C., Al-Radi O., Viola N., Coles J.G., Van Arsdell G.S., Caldarone C.A. Primary sutureless repair for infants with mixed total anomalous pulmonary venous drainage. Ann Thorac. Surg. 2010;90:862-868. doi: 10.1016/j.athoracsur.2010.05.007.

22. Yun T.J., Coles J.G., Konstantinov I.E., Al-Radi O.O., Wald R.M., Guerra V., de Oliveira N.C., Van Arsdell G.S., Williams W.G., Smallhorn J., Caldarone C.A. 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: 167-174. doi: 10.1016/j.jtcvs.2004.08.043.