Surgery for pulmonary venous stenosis after total anomalous pulmonary venous connection repair: Midterm results of 9 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Cheng ,  YAN Jun , LUO Guohua , ZHAO Yuchen , DONG Shuo , ZHANG Yajuan

Department of Cardiac Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

YAN Jun, Email: yanjun.1112@aliyun.com

Keywords：

Total anomalous pulmonary venous connection; pulmonary vein stenosis; surgical treatment

DOI：

10.7507/1007-4848.202007064

Video：

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Objective To review our experience of reoperations for pulmonary venous stenosis (PVS) after total anomalous pulmonary venous connection (TAPVC) repair for the past decade in Fuwai Hospital.Methods Nine patients underwent reoperation for PVS between 2009 and 2019 in Fuwai Hospital, including 4 males and 5 females with an average age of 5.10±5.00 years. The patients were divided into a sutureless group (n=3) and a non-sutureless group (n=6). Clinical data were reviewed and analyzed.Results For primary TAPVC type, 4 patients were supracardiac, 2 patients were cardiac, 1 patient was infracardiac, and 2 patients were mixed-type anomaly. The median cardiopulmonary bypass time was 95 (63, 208) min, aortic clamping time was 58 (30, 110) min, ICU stay was 24 (24, 2 136) h. Early hospital death occured in 1 (11.1%) patient. One (11.1%) patient with single ventricle physiology had hospital comorbidity, who underwent hemofitration therapy. The follow-up time was 11.9 (2.2, 18.0) months, during which 1 patient died of restenosis of pulmonary vein and another patient died of stroke. No statistically significant difference was found between the sutureless group and non-sutureless group in postoperative or follow-up results (P>0.05). Conclusion Surgery is effective for treatment of PVS after repair of TAPVC, yet with a realatively high morbidity and mortality. The advantage of sutureless repair over conventional repair for this particular group of patients is yet to be verified.

Citation： WANG Cheng, YAN Jun, LUO Guohua, ZHAO Yuchen, DONG Shuo, ZHANG Yajuan. Surgery for pulmonary venous stenosis after total anomalous pulmonary venous connection repair: Midterm results of 9 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(11): 1330-1333. doi: 10.7507/1007-4848.202007064 Copy

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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.	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.
4.	Hancock Friesen CL, Zurakowski D, Thiagarajan RR, et al. Total anomalous pulmonary venous connection: An analysis of current management strategies in a single institution. Ann Thorac Surg, 2005, 79(2): 596-606.
5.	Hickey EJ, Caldarone CA. Surgical management of post-repair pulmonary vein stenosis. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2011, 14(1): 101-108.
6.	Shaw FR, Chen JM. Surgical considerations in total anomalous pulmonary venous connection. Semin Cardiothorac Vasc Anesth, 2017, 21(2): 132-137.
7.	Kalfa D, Belli E, Bacha E, et al. Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. J Thorac Cardiovasc Surg, 2018, 156(1): 278-286.
8.	Devaney EJ, Ohye RG, Bove EL. Pulmonary vein stenosis following repair of total anomalous pulmonary venous connection. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006: 51-55.
9.	Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: Risk factors for adverse outcome. Eur J Cardiothorac Surg, 2003, 24(1): 28-36.
10.	Kato H, Fu YY, Zhu J, et al. Pulmonary vein stenosis and the pathophysiology of "upstream" pulmonary veins. J Thorac Cardiovasc Surg, 2014, 148(1): 245-253.
11.	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.
12.	Yun TJ, Coles JG, Konstantinov IE, et al. 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(1): 167-174.
13.	Tremblay C, Yoo SJ, Mertens L, et al. Sutureless versus conventional pulmonary vein repair: A magnetic resonance pilot study. Ann Thorac Surg, 2018, 105(4): 1248-1254.

1. Herlong JR, Jaggers JJ, Ungerleider RM. Congenital Heart Surgery Nomenclature and Database Project: Pulmonary venous anomalies. Ann Thorac Surg, 2000, 69(4 Suppl): S56-S69.
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. 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.
4. Hancock Friesen CL, Zurakowski D, Thiagarajan RR, et al. Total anomalous pulmonary venous connection: An analysis of current management strategies in a single institution. Ann Thorac Surg, 2005, 79(2): 596-606.
5. Hickey EJ, Caldarone CA. Surgical management of post-repair pulmonary vein stenosis. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2011, 14(1): 101-108.
6. Shaw FR, Chen JM. Surgical considerations in total anomalous pulmonary venous connection. Semin Cardiothorac Vasc Anesth, 2017, 21(2): 132-137.
7. Kalfa D, Belli E, Bacha E, et al. Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. J Thorac Cardiovasc Surg, 2018, 156(1): 278-286.
8. Devaney EJ, Ohye RG, Bove EL. Pulmonary vein stenosis following repair of total anomalous pulmonary venous connection. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006: 51-55.
9. Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: Risk factors for adverse outcome. Eur J Cardiothorac Surg, 2003, 24(1): 28-36.
10. Kato H, Fu YY, Zhu J, et al. Pulmonary vein stenosis and the pathophysiology of "upstream" pulmonary veins. J Thorac Cardiovasc Surg, 2014, 148(1): 245-253.
11. 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.
12. Yun TJ, Coles JG, Konstantinov IE, et al. 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(1): 167-174.
13. Tremblay C, Yoo SJ, Mertens L, et al. Sutureless versus conventional pulmonary vein repair: A magnetic resonance pilot study. Ann Thorac Surg, 2018, 105(4): 1248-1254.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgery for pulmonary venous stenosis after total anomalous pulmonary venous connection repair: Midterm results of 9 patients

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