Long-term outcome of infants with single ventricle and total anomalous pulmonary venous connection

Background and methods: Between January 1, 1984, and December 1, 1997, 73 i nfants with functional single ventricle and total anomalous pulmonary venou s connection were admitted to our institution. A retrospective review was u ndertaken to determine factors influencing survival. Results: Heterotaxy sy ndrome was present in 52 patients and hypoplastic left heart syndrome in 14 , Obstructed total anomalous pulmonary venous connection was present in 21 patients. The pulmonary venous connection was supracardiac in 32 patients, cardiac in 21. patients, infracardiac in 13, and mixed in 7, Twelve patient s died before the operation. The remaining 61 patients underwent surgery at a median age of 5 days (range 1 day-2.5 years). Overall survival was 45% a t 6 months of age, 37% at 1 year, and 19% at 5 years. Survival for patients undergoing surgery was 54% at 6 months of age, 44% at 1 year, and 23% at 5 years. By univariate analysis with the Cox proportional hazards model, you nger age at the time of the initial operation and repair of total anomalous pulmonary venous connection were predictors of mortality Lung tissue from 14 patients was available for histologic examination. The pulmonary veins w ere dilated and wall thickness was increased. Increased muscularization of the arteries was seen in 11 patients. Conclusions: The long-term prognosis for children undergoing staged reconstructive operations for single ventric le and total anomalous pulmonary venous connection is poor. Early mortality is high and late death is a continuing risk. Development of the pulmonary vasculature, especially the pulmonary veins, is abnormal, even in children without clinical evidence of pulmonary venous obstruction.