F. Lacour-gayet et al., Surgical management of progressive pulmonary venous obstruction after repair of total anomalous pulmonary venous connection, J THOR SURG, 117(4), 1999, pp. 679-685
Citations number
13
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background: The occurrence of a progressive pulmonary venous obstruction af
ter the repair of the total anomalous pulmonary venous connection is a seve
re complication. Objectives: The objectives of this study were to retrospec
tively review the patients with this condition and to report our experience
with a new surgical technique with a sutureless in situ pericardium repair
, Methods: Of 178 patients who underwent correction of total anomalous pulm
onary venous connection, 16 patients (9%) experienced the development of a
progressive pulmonary venous obstruction in a median interval of 4 months (
5 weeks-12 years). Three patients had isolated anastomotic stenosis, 4 pati
ents had isolated pulmonary venous ostial stenosis, and 9 patients had both
. Pulmonary venous obstruction was bilateral in 7 patients. The surgical pr
ocedures used at reoperation included 8 patch enlargements, 5 ostial endart
erectomies, 1 intraoperative stenting, and 7 sutureless in situ pericardium
repairs. Results: There were 4 deaths after reoperation (4 of 15 patients;
27%). The only significant mortality risk factor was the bilateral locatio
n of the pulmonary venous obstruction (P = .045). In patients with isolated
anastomotic stenosis or with only 1 pulmonary venous ostial stenosis (n =
5), there was no death, except the patient presenting with a single ventric
le, In patients with 2 or more pulmonary venous ostial stenoses (n = 10), t
here were 3 deaths; 5 of the 7 survivors were successfully treated with the
in situ pericardial technique, with normalized pulmonary artery pressure a
t a mean follow-up of 26 months. Conclusion: Progressive pulmonary venous s
tenosis after repair of total anomalous pulmonary venous connection remains
a severe complication when bilateral. The sutureless in situ pericardial r
epair offers a satisfactory solution, particularly on the right side.