The beneficial hemodynamic effects of selective patent vertical vein following repair of obstructed total anomalous pulmonary venous drainage in infants

Objectives: Postoperative low cardiac output may persist after repair of to tal anomalous pulmonary venous drainage (TAPVD) because of a relatively sma ll and non-compliant left atrium and left ventricle. We examined the effect s of selective vertical vein patency on postoperative hemodynamics. Methods : Thirty-four patients less than 3 months of age with TAPVD were operated f rom July 1993 to June 2000. The mean age at operation was 21 +/- 8 days (ra nge, 3-62 days) and the mean weight was 3 +/- 0.2 kg (range, 2-4.1 kg). Sup racardiac type drainage was found in 12 (35%). cardiac in three (9%), mixed in one (3%). and infracardiac in 18 (53%) patients. Twenty-two patients (6 5%) had obstructed venous drainage. All operations were performed with deep hypothermic circulatory arrest. Supracardiac, mixed and infracardiac types were repaired through a posterior approach, whereas, in the cardiac type, the coronary sinus was unroofed and the atrial septal defect was patched. T he decision whether to keep the vertical vein open was made at the end of t he operation and was based on the hemodynamic state of the patient. Results : There were no operative deaths. The suture on the vertical vein was relea sed in 22 patients who had obstructed pulmonary venous drainage (infracardi ac type, n = 18; supracardiac type, n = 3: and mixed type. n = 1), resultin g in a significant drop in the left atrial pressure from 19 +/- 2 to 12 +/- 2 mmHg (P < 0.05), and in the mean pulmonary artery pressure from 42 +/- 6 to 35 +/- 3 mmHg (P < 0.05), associated with an immediate increase in the mean arterial blood pressure from a mean of 46 +/- 3 to 60 +/- 4 mmHg (P < 0.05). During a mean follow-up of 38 +/- 6 months (range. 8-71 months), the re were no late deaths. Follow-up. two-dimensional echocardiography with Do ppler studies demonstrated good left ventricular function and trivial or no left to right shunt through the vertical vein in those patients in whom th e snare was released. Conclusions: Maintaining the vertical vein patent in a selective group of patients with infracardiac total anomalous venous drai nage contributes to a favorable outcome following surgery. (C) 2001 Elsevie r Science B.V. All rights reserved.